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This is VAERS ID 274084

Case Details

VAERS ID: 274084 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Florida  
Vaccinated:2007-02-19
Onset:2007-02-19
   Days after vaccination:0
Submitted: 2007-03-11
   Days after onset:20
Entered: 2007-03-16
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB19AA / UNK UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 001N / UNK UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1968AA / UNK UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1497F / UNK UN / UN

Administered by: Private       Purchased by: Private
Symptoms: Laceration, Oxygen saturation, Syncope, Tooth repair
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: PO2 99%
CDC Split Type:

Write-up: 2-19-07 child had well check up, received vaccines of Gardasil, Hep A, Menactra, Varicella. Approx at 3:00pm had syncopal episode on the way out of the office. First aid rendered for lip laceration. B/P and vital signs checked, reverse trendelenburg position. Sent to dental office for tooth repair.


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