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This is VAERS ID 274297

Case Details

VAERS ID: 274297 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Virginia  
Vaccinated:2007-02-06
Onset:2007-02-06
   Days after vaccination:0
Submitted: 2007-03-14
   Days after onset:35
Entered: 2007-03-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / 2 LA / IM

Administered by: Military       Purchased by: Military
Symptoms: Balance disorder, Dizziness, Feeling cold, Loss of consciousness, Tunnel vision
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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Optic nerve disorders (broad), Retinal disorders (narrow), 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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Blood pressure, 02/07/07, 110/7
CDC Split Type: WAES0702USA03468

Write-up: Initial and follow up information has been received from a registered nurse and a health care provider, concerning a 12 year old female patient who on 21-NOV-2006 (previously reported as within the last 3 months) was vaccinated intramuscularly in the right deltoid, with an 0.5 mL dose of GARDASIL vaccine (Lot #653937/0637F), and on 06-FEB-2007, was vaccinated IM in the left deltoid with an additiional 0.5 mL dose of GARDASIl vaccine (Lot # 653937/0637F). After receiving the dose on 06-FEB-2007. Subsequently the patient experienced dizziness to the point of losing consciousness. The event lasted for a matter of seconds. The patient was well enough to leave in a few minutes. Additional information has been requested. This is in follow-up to report (s) previously submitted on 3/14/2007. Follow up information from the health care provider who administered the vaccine, stated that on 06-FEB-2007 after the vaccination, the patient "was really cold, she got tunnel vision and began to lose her balance." The patient rested for 15 minutes, and was sent home after evaluation by the nurse. The patient was considered to have recovered on the same day. No further information is expected.


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