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This is VAERS ID 276042

Case Details

VAERS ID: 276042 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Florida  
Vaccinated:2007-04-11
Onset:2007-04-11
   Days after vaccination:0
Submitted: 2007-04-11
   Days after onset:0
Entered: 2007-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0012U / 1 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Anxiety, Computerised tomogram normal, Concussion, Confusional state, Crying, Fall, Head injury, Loss of consciousness
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), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Depression (excl suicide and self injury) (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 KNOWN
Current Illness: NONE KNOWN
Preexisting Conditions: NONE KNOWN
Allergies:
Diagnostic Lab Data: TRANSFERRED BY AMBULANCE TO HOSP PER MOTHERS REPORT: CLIENT GIVEN IV FLUIDS AND CT SCAN. MOTHER REPORTS CT SCAN NORMAL BUT DID NOT R/O OR CONFIRM CONCUSSION CLIENT RELEASED FROM HOSPITAL AROUND NOON. MOTHER REPORTS ED RECOMMENDED F/U CT SCAN IN 3 MONTHS.
CDC Split Type:

Write-up: APPROXIMATELY 10 MINUTES AFTER VACCINE ADMINISTRATION CLIENT PASSED OUT FALLING AND HITTING HER HEAD. CLIENT AROUSED IN A FEW SECONDS. VITAL SIGNS CHECKED. APPROXIMATELY 20 MINUTES LATER CLIENT REPORTED FEELING ANXIOUS AND CONFUSED, CRYING, AMBULANCE CALLED


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