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This is VAERS ID 278505

Case Details

VAERS ID: 278505 (history)  
Form: Version 1.0  
Age: 18.0  
Gender: Female  
Location: Texas  
Vaccinated:2007-05-14
Onset:2007-05-14
   Days after vaccination:0
Submitted: 2007-05-14
   Days after onset:0
Entered: 2007-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1424F / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2171AA / 1 LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Cold sweat, Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (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:
Current Illness:
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt C/O feeling dizzy, pt fainted, skin cold and clammy; pt regained consciousness and vital were within normal range; pt rested with a cold pack to her forehead.


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