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This is VAERS ID 275814

Case Details

VAERS ID: 275814 (history)  
Age: 11.0  
Gender: Female  
Location: Oklahoma  
Vaccinated:2007-04-09
Onset:2007-04-09
   Days after vaccination:0
Submitted: 2007-04-09
   Days after onset:0
Entered: 2007-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1208F / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR 12142AA / 0 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B015A / 0 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Anxiety, Fall, 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), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approx 2-3 min after vaccine admin, pt experienced syncope episode with 2-3 sec loss of consciousness and fall to ground from own height. Pt had not eaten that day and had expressed anxiety re: immuniz. prior to event vs immediately after event BP-110/70; P-130/min, R-24/min, O2 sat 98%. Placed pt in recumbent position and gave her mild to drink. Fs OS-109 mg/dl. Fully recovered w/in 10 min BP-100/70; P-88/mm; R-16/mn O2 Sat 99%. Recovered at 11:55 in stable condition.


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