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This is VAERS ID 278022

Case Details

VAERS ID: 278022 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2007-05-04
Onset:2007-05-04
   Days after vaccination:0
Submitted: 2007-05-04
   Days after onset:0
Entered: 2007-05-07
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0384U / 1 RA / IM

Administered by: Private       Purchased by: Other
Symptoms: Convulsion, Fall, Head injury, Respiratory arrest, Syncope, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Respiratory failure (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: None
Current Illness: URI
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt had syncopal episode 2 minutes after injection given. Fell and hit back of head-had seizure lasting 1 min was unresponsive, not breathing x 30 min. Administered ammonia pads and called 911


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