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This is VAERS ID 272487

Case Details

VAERS ID: 272487 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: North Carolina  
   Days after vaccination:0
Submitted: 2007-02-14
   Days after onset:30
Entered: 2007-02-15
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 09611F / 1 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Immediate post-injection reaction, 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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: Sulfonamide allergy, Penicillin allergy.
Preexisting Conditions:
Diagnostic Lab Data: Blood pressure, 01/15/07 96/72; total heartbeat count, 01/15/07, 104; pulse oximetry, 01/15/07 99%
CDC Split Type: WAES0701USA03429

Write-up: Information has been received from a registered nurse concerning a 14 year old female who on 15-JAN-2007 was vaccinated, intramuscularly with the first dose of HPV vaccine (yeast), (lot # 654389/0961F). On 15-JAN-2007 the patient fainted after receiving the vaccination. The patient was seen in the Emergency Room (ER) following vaccination and "no problems were found". At the time of the report, it was unspecified, if the patient recovered. Additional information was received on 11-APR-2007. The registered nurse indicated that on 15-JAN-2007 the patient''s blood pressure was 56/72 and heart rate was 104. On 15-JAN-2007, at 15:10, the patient was vaccinated with her first dose of Gardisil intramuscular (left deltoid), became pale immediately, laid down for approximately 5 minutes, got up, started walking down the hall, and passed out. The patient was taken to an ER, oxygen saturation was 99% (no other vital signs were taken). It was noted that the patient did report nausea. The patient did not experience rashes, hives, or difficulty breating. The patient was not ill at the time of vaccination. Additional information is not expected.

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