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This is VAERS ID 277665

Case Details

VAERS ID: 277665 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: New York  
   Days after vaccination:0
Submitted: 2007-04-30
   Days after onset:7
Entered: 2007-05-01
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0014U / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Convulsion, Hypotension, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), 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: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0704USA05616

Write-up: Information has been received from a physician concerning a 16 year old female with no pertinent medical history who on 23-APR-2007 was vaccinated, intramuscularly, with a 0.5 ml first dose Gardasil (lot #653736/0014U). There were no concomitant medication. On 23-APR-2007, while attempting to leave the physician''s office, the patient "appeared to have a seizure" and lost consciousness. It was reported that the incident lasted only a few seconds. When the patient regained consciousness it was discovered that her blood pressure was low. On 23-APR-2007, the patient recovered and was able to leave the physician''s office with her mother. Upon internal review, "appeared to have a seizure" was considered to be an other important medical event. Additional information has been requested.

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