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This is VAERS ID 275915

Case Details

VAERS ID: 275915 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Indiana  
Vaccinated:2007-04-02
Onset:2007-04-02
   Days after vaccination:0
Submitted: 2007-04-03
   Days after onset:1
Entered: 2007-04-10
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0014U / 3 LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Loss of consciousness, Skin laceration
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), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), 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: None
Current Illness: None
Preexisting Conditions: Allergic to Ceclor
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Student received Gardasil at 1500 on 4/2/07 - tolerated vaccine well - returned to dorm - subsequently passed out in dorm bathroom causing laceration to head.


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