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This is VAERS ID 275377

Case Details

VAERS ID: 275377 (history)  
Form: Version 1.0  
Age: 18.0  
Gender: Female  
Location: Indiana  
Vaccinated:2007-03-12
Onset:2007-03-12
   Days after vaccination:0
Submitted: 2007-03-28
   Days after onset:16
Entered: 2007-04-02
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB129AA / 2 RA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 2 RA / -

Administered by: Private       Purchased by: Private
Symptoms: Convulsion, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Syncope and short syncopal seizure after Gardasil x2


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