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This is VAERS ID 272287

Case Details

VAERS ID: 272287 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Michigan  
Vaccinated:2006-12-29
Onset:2006-12-29
   Days after vaccination:0
Submitted: 2007-04-06
   Days after onset:97
Entered: 2007-02-15
   Days after submission:49
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / UN

Administered by: Private       Purchased by: Other
Symptoms: Abdominal discomfort, Asthenia, Dizziness, Fall, Loss of consciousness
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), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0701USA00616

Write-up: Information has been received from a physician concerning a female patient who on an unspecified date was vaccinated with the first dose of Gardasil. subsequently, following vaccination, the patient loss consciousness. The patient regained consciousness after a few minutes. Unspecified medical attention was sought. Additional information has been requested. This is in follow-up to report (s) previously submitted on 2/14/2007. Information has been received from a physician and a medical assistant concerning a 15 year old female with no past medical history, who on 29-DEC-2006, at 11:15 AM was vaccinated in the right arm with the first dose of GARDASIL (0.5 ml). There were no illnesses at time of vaccination. Subsequently, following vaccination, on 29-DEC-2006 at 11:20 AM the patient felt week and dizzy, then stated that she felt sick to her stomach. The patient suddenly fell forward into her mother''s arms, and passed out. The patient was passed out for less then a minute. The patient was given something to eat and drink and was kept in the office for 30 minutes. After the 30 minutes, the patient stated that she was fine. No further information is expected.


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