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This is VAERS ID 272317

Case Details

VAERS ID: 272317 (history)  
Form: Version 1.0  
Age: 20.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2006-12-22
Onset:2006-12-22
   Days after vaccination:0
Submitted: 2007-02-14
   Days after onset:54
Entered: 2007-02-15
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 1 LA / IM

Administered by: Private       Purchased by: Other
Symptoms: 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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: WAES0701USA01401

Write-up: Information has been received from a registered nurse concerning a 20 year old female who on 22-DEC-2006 was vaccinated with Gardasil (yeast) (lot number 653978/0955F). On 22-DEC-2006 the patient passed out after vaccination. Additional information has been requested. This is in follow-up to report(s) previously submitted on 2/14/2007. Initial and follow-up information has been received from a registered nurse concerning a 20 year old female student with no reported allergies who, at 10:00AM on 22-DEC-2006, was vaccinated into the left deltoid with a first dose of GARDASIL (Lot# 653978/0955F). There was no illness at the time of vaccination. On 22-DEC-2006, after the vaccination, the patient felt faint and passed out for a short time. The nurse reported that the patient was watched closely and felt fine after a while and then left the office, recovered the same day, 22-DEC-2006. Additional information is not expected.


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