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This is VAERS ID 274582

Case Details

VAERS ID: 274582 (history)  
Form: Version 1.0  
Age: 25.0  
Gender: Female  
Location: Alabama  
Vaccinated:2007-02-21
Onset:2007-02-21
   Days after vaccination:0
Submitted: 2007-03-14
   Days after onset:20
Entered: 2007-03-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0014U / 1 UN / IM

Administered by: Private       Purchased by: Private
Symptoms: Chest discomfort, Dizziness, Fall, Head injury, Impaired work ability, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (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), Accidents and injuries (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? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Fatigue; Weakness
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES0702USA04019

Write-up: Information has been received from a health care professional concerning a 25 year old female with no medical history and no allergies who on 21-FEB-2007 was vaccinated with GARDASIl vaccine (lot # 653736/0014U), intramuscularly. There was no concomitant medication. Later that evening she passed out. She hit her head when she fell to the floor. It was reported to be unknown if treatment was required. She called the doctor this morning and was taking the day off from work. Additional information has been requested. This is in follow-up to report (s) previously submitted on 3/14/2007. Follow up information was received which stated that the patient had weakness and fatigue at the time of the first intramuscular vaccination in the left deltoid of GARDASIl vaccine (lot # 653736/0014U) on 21-FEB-2007 at 16:45. At 17:30 that same day, post vaccination, the patietn expereinced lightheadedness, dizziness, chest tightening and passed out. No treatment was reported. At the time of the report it was unknown if the patient had recovered. Additional information has been requested.


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