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This is VAERS ID 276064

Case Details

VAERS ID: 276064 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Rhode Island  
Vaccinated:2007-03-22
Onset:2007-03-22
   Days after vaccination:0
Submitted: 2007-04-11
   Days after onset:20
Entered: 2007-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / 1 - / IM

Administered by: Private       Purchased by: Public
Symptoms: Hypotension, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (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), 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: Ceclor allergy (rash)
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Passed out in hallway after receiving vaccine. BP 90/30 then elevated to 98/60 took 15 mins to he able to sit up BP normal taken prior to exam 94/60 P 84


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