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This is VAERS ID 278603

Case Details

VAERS ID: 278603 (history)  
Form: Version 1.0  
Age: 18.0  
Gender: Female  
Location: Florida  
Vaccinated:2007-03-14
Onset:2007-03-14
   Days after vaccination:0
Submitted: 2007-05-08
   Days after onset:55
Entered: 2007-05-15
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0186U / 1 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Loss of consciousness, Pallor
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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), 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: none
Preexisting Conditions: Allergy to Clindamycin
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: After injection of Gardasil vaccine 0.5 ml, Pt was sitting talking to her mother. She became pale and passed out for a few minutes. She was revived and walked to exam table. After lying down for 15-20 min.-left the office doing well.


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