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This is VAERS ID 274598

Case Details

VAERS ID: 274598 (history)  
Form: Version 1.0  
Age: 21.0  
Gender: Female  
Location: New York  
Vaccinated:2007-01-29
Onset:2007-01-29
   Days after vaccination:0
Submitted: 2007-03-14
   Days after onset:43
Entered: 2007-03-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / 1 UN / IM

Administered by: Private       Purchased by: Private
Symptoms: Concussion, Dizziness, Head injury, 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), Accidents and injuries (narrow), 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES0702USA04255

Write-up: Information has been received from a registered nurse concerning a 21 year old female with no pertinent medical history and no drug reactions or allergies who on 29-JAN-2007 was vaccinated intramuscularly with a 0.5 mL dose of HPV (Lot unspecified by reporter). There was no concomitant medication. On 29-JAN-2007 the patient fainted while walking to the waiting room. The patient hit her head on the floor and suffered a concussion. The patient was rushed to an emergency room in an ambulance. She was release later that day. At the time of the report, the patient had recovered. Additional information has been requested. This is in follow-up to report (s) previously submitted on 3/14/2007. Initial and follow-up information has been received from a licensed practical nurse concerning a 21 year old female, whose repported weight was 176 pounds and whose reported height was 65 inches with no pertinent medical history and no illness at the time of vaccination and no drug reactions or allergies who on 29-JAN-2007, at approximately 12:45 P.M., was vaccinated intramuscularly, into the deltoid muscle with the first 0.5 mL dose of GARDASIL vaccine (Lot #654702/0011U). There was no concomitant medication. It was reported that after the vaccination at 12:55 P.M. (also reported as 1:10 P.M.), the patient proceeded to feel dizzy (also reported as "faint") resulting in the patient "passing out" and reported as fainting while walking to the waiting room. The patient hit her head on scale, which was on the floor. The patient was rushed to an emergency roon in an ambulance and was diagnosed with concussion. She was released later that day. At the time of the report, the patient had recovered. Additional information has been requested.


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