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This is VAERS ID 275993

Case Details

VAERS ID: 275993 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: Virginia  
   Days after vaccination:0
Submitted: 2007-04-10
   Days after onset:15
Entered: 2007-04-11
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Computerised tomogram normal, Dizziness, Fall, Head injury, Loss of consciousness, Neck injury, Pyrexia
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), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: LOESTRIN
Current Illness: Sulfonamide allergy
Preexisting Conditions:
Diagnostic Lab Data: Head computed axial 03/26/07 - Negative
CDC Split Type: WAES0704USA00946

Write-up: Information has been received from a licensed practical nurse (LPN), via company representative, concerning a 16 year old female patient with a sulfonamide allergy, who on 26-Mar-2007 was vaccinated with a dose of 0.5ml, IM, of Gardasil (Lot # 656372/0243U). Concomitant therapy included LOESTRIN. The nurse reported that on 26-MAR-2007, "about 15 minutes" after the vaccination, the patient felt dizzy, passed out, "hitting her face and head as she fell." The patient was taken to the ER, and was treated wit intravenous fluids and TYLENOL. A computed tomography (CT) was performed to evaluate for head and neck injury; the CT result was negative. The nurse added that the patient also developed a low grade fever (date not specified). At the time of this report, the nurse indicated that the patient had recovered from the events. Felt dizzy, passed out, hitting her face and head as she fell, and low grade fever were considered to be an other important medical event. Additional information has been requested.

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