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This is VAERS ID 274084

Case Details

VAERS ID: 274084 (history)  
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 / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 001N / - UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1968AA / - UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1497F / - 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
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
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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