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This is VAERS ID 276063

Case Details

VAERS ID: 276063 (history)  
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 / 0 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1300F / 1 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
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: anaphylaxis to bees (epi pen)
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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