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This is VAERS ID 272785

Case Details

VAERS ID: 272785 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2007-02-19
Onset:2007-02-19
   Days after vaccination:0
Submitted: 2007-02-20
   Days after onset:1
Entered: 2007-02-21
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0954F / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2644AA / 1 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0942R / 2 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Dizziness, Loss of consciousness, 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), 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: NONE
Current Illness: NONE
Preexisting Conditions: Keartosis Pilaris
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 5 minutes after Pt received vaccines, fainted LOC lasted about 5 seconds then pt dizzy and lightheaded for about 5-10 min and relieved by 10 min resting supine then 5 min sitting and drinking gatorade/eating cheese crackers.


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