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This is VAERS ID 276063

Case Details

VAERS ID: 276063 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Rhode Island  
Vaccinated:2007-04-05
Onset:2007-04-05
   Days after vaccination:0
Submitted: 2007-04-11
   Days after onset:6
Entered: 2007-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1300F / 2 RA / SC

Administered by: Private       Purchased by: Public
Symptoms: Blood pressure decreased, Hyperhidrosis, Pallor, Pharyngolaryngeal pain, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: anaphylaxis to bees (epi pen)
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 2-3 min after receiving vaccination while standing had syncopal episode, sweaty, shaking sore throat white lips after 5-10 mins. 12 cups of H2O felt better BP 90/60 BP normal taken prior to exam 106/62 P 80


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