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This is VAERS ID 274712

Case Details

VAERS ID: 274712 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: New York  
Vaccinated:2005-02-15
Onset:2007-02-16
   Days after vaccination:731
Submitted: 2007-03-14
   Days after onset:25
Entered: 2007-03-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0954F / 1 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Blood pressure normal, Diarrhoea, Dizziness, Fall, Loss of consciousness
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), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Noninfectious diarrhoea (narrow), 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: calcium (unspecified); hormonal contraceptive; prednisone 5mg; vitamins (unspecified)
Current Illness: Autoimmune hepatitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES0702USA04396

Write-up: Information has been received from a registered nurse concerning a 21 year old female patient with autoimmune hepatitis, who on 15 Feb 2005 was vaccinated with a dose, 0.5ml, IM, of Gardasil. Concomitant suspect therapy included Adacel, and other concomitant medication included birth control pills, prednisone, vitamins (unspecified) and calcium (unspecified). The nurse reported that on 15 Feb 2007, "20 hours later," the patient "felt lightheaded and passed out. She came to and when she got up she passed out and fell to the floor." The nurse further stated that "both episodes were very brief." On approximately 16 Feb 2007 ("later") the patient "had one episode of diarrhea." On the morning of 16 Feb 2007, the nurse stated that the patient was seen by the doctor and "blood pressure was normal and injection site looked fine. No treatment required." At the time of this report, the patient had recovered. Additional information has been requested. Information received 04/03/2009. The nurse confirmed that the patient actually experienced "two concurrent bried syncopal episodes." Additional information has been requested.


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