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This is VAERS ID 275509

Case Details

VAERS ID: 275509 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2007-04-02
Entered: 2007-04-03
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / 1 - / IM

Administered by: Public       Purchased by: Other
Symptoms: Electrocardiogram QT prolonged, Heart rate increased, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Torsade de pointes, shock-associated conditions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: electrocardiogram - prolonged Q-T, total heartbeat count over
CDC Split Type: WAES0703USA04642

Write-up: Information has been received from a nurse practitioner concerning a 13 year old female who on an unspecified date was vaccinated with first dose, single dose vial, of Gardasil (lot # not reported) IM injection. On an unspecified date, within 10 minutes of receiving the vaccination, the patient passed out. The patient''s heart rate was over 200. The patient passed out a total of three times. Medical attention was sought. The patient was hospitalized as a result of the experience. At the time of reporting, the patient had prolonged Q-T and was being seen by a cardiologist for the condition. The outcome of the events was unknown. The reporter considered the events to be immediately life-threatening. Additional information has been requested.


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