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This is VAERS ID 272276

Case Details

VAERS ID: 272276 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: New Hampshire  
Vaccinated:2006-12-08
Onset:2006-12-08
   Days after vaccination:0
Submitted: 2007-02-14
   Days after onset:68
Entered: 2007-02-15
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0954F / 1 UN / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / 1 UN / -
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK UN / -

Administered by: Private       Purchased by: Private
Symptoms: Fall, Feeling abnormal, Headache, Injury, Loss of consciousness, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: WAES0701USA00266

Write-up: Information has been received from a physician concerning a 12 year old female with no illness at the time of vaccination who on 08-DEC-2006 was vaccinated with a 0.5 ml first dose of Gardasil (yeast) (lot 653938/0954F). On 08-DEC-2006, the patient was concomitantly vaccinated with a first dose of Menatra, a dose of influenza virus vaccine (unspecified) and a dose of Boostrix. On 08-Dec-2006, the patient fainted shortly after vaccination. She fell from a standing position and hit the back of head on the floor. She was unconscious for approximately 30 seconds,a and then was dazed and pale. The patient was "ok" after a few minutes. The patient complained of a headache, frontal to occipital. The patient was "ok" at home later that evening. The patient recovered with no sequalae on 08-DEC-2006. Additional information is not expected.


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