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This is VAERS ID 272623

Case Details

VAERS ID: 272623 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: Maryland  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2007-02-14
Entered: 2007-02-15
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Injection site pain, 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), Extravasation events (injections, infusions and implants) (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? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tetanus toxoid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0702USA00207

Write-up: Information has been received from a nurse practitioner concerning a 16 year old female who on an unspecified date was vaccinated intramuscularly with the first dose of Gardasil. Concomitant therapy included a tetanus toxoid shot. Immediately with vaccination, the patient developed injection site stinging and the patient passed out for a few seconds. The patient sought unspecified medical attention. The nurse practitioner reported that the patient was fine after a few seconds and was able to drive home. Thee was no lot number provided. Additional information has been requested.


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