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This is VAERS ID 276066

Case Details

VAERS ID: 276066 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: Rhode Island  
Vaccinated:2007-03-20
Onset:2007-03-20
   Days after vaccination:0
Submitted: 2007-04-11
   Days after onset:22
Entered: 2007-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 1 RA / IM

Administered by: Private       Purchased by: Public
Symptoms: Hyperhidrosis, Hypotension, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (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: Doxycycline 1xd on/off for ache
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Administered vaccine with on incidents. Suddenly with in 2-3 mins. became faint, sweaty, pale layed pt down on exam table. Responded immediately BP 98/56 AP 68. Observation, cool drink rest no further incidence-discharged with mom (did not drug herself).


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