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This is VAERS ID 275112

Case Details

VAERS ID: 275112 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: California  
Vaccinated:2007-03-19
Onset:2007-03-19
   Days after vaccination:0
Submitted: 2007-03-28
   Days after onset:9
Entered: 2007-03-29
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Anxiety, Convulsion, Loss of consciousness, Pain
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Unknown
CDC Split Type: WAES0703USA04361

Write-up: Information has been received from a physician, via a company representative, concerning a 13 year old female patient, who on 19-MAR-2007 was vaccinated with the first dose, IM, of Gardasil. The physician reported that "approximately 3 minutes after receiving the first dose of the vaccine, the patient passed out," and then "experienced a seizure that lasted approximately 2 minutes." The physician stated that the seizure was probably related to pain or anxiety, and indicated that the patient''s status had improved after she received therapy (therapy unspecified). Seizure was considered to be an other important medical event. Additional information has been requested.


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