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This is VAERS ID 276160

Case Details

VAERS ID: 276160 (history)  
Form: Version 1.0  
Age: 18.0  
Gender: Female  
Location: Nebraska  
Vaccinated:2007-01-15
Onset:2007-01-15
   Days after vaccination:0
Submitted: 2007-04-06
   Days after onset:80
Entered: 2007-04-09
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1427F / 1 UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / UNK UN / UN
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK UN / UN

Administered by: Private       Purchased by: Private
Symptoms: Dizziness, Dyskinesia, Gaze palsy, Immediate post-injection reaction, Muscle twitching, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Dystonia (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), 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: Unknown
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES0703USA01014

Write-up: Information has been received from a registered nurse concerning an 18 year old female patient who on 15, Jan 2007 was vaccinated with a first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast) (lot # 655619/1427F). Concomitant suspect vaccination included a dose of diphtheria toxoid (+) pertussis acellular 3-component vaccine (+) tetanus toxoid (BOOSTRIX) and a dose of meningoxoccal ACYW conj vaccine (dip toxoid) (MENACTRA). On 15, Jan 2007, within 2 minutes after her vaccinations. the patient became pale and fainted. The nurse also reported that while unconscious, the patient had jerking motions which lasted a couple of seconds. The patient was reported to have rested in the office for 15 minutes and then went home recovered. Additional information has been requested. This is in follow-up to report(s) previously submitted on 4/6/2007. On 07-May-2007 follow-up information was received from a registered nurse who indicated that the patient, after immediately receiving the vaccine, became lightheaded and appeared to faint. Her eyes rolled back and she became pale with twitching and jerking motions of the upper extremities which lasted for less than 5 seconds. The patient spontaneously recovered after lying down. No further information was provided.


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