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This is VAERS ID 276602

Case Details

VAERS ID: 276602 (history)  
Form: Version 1.0  
Age: 18.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2007-04-03
Onset:2007-04-03
   Days after vaccination:0
Submitted: 2007-04-12
   Days after onset:9
Entered: 2007-04-17
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB14BAA / 1 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1968AA / 1 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC526014AA / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Gaze palsy, Loss of consciousness, Muscle rigidity, Pallor, Staring
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), 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:
Preexisting Conditions: Allergic rhinitis, exercise induced asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 5 minutes after HPV vaccine was given patient became pale, her eyes rolled back in her head, and she became rigid, she lost conscious 30 seconds. When she came to she had postical s/s of a blank stare for about 5-10 seconds. She did become A x O x S. BP 116/ 78 P 64, Pulse O2 97%. Before vaccine BP 115/65


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