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This is VAERS ID 279548

Case Details

VAERS ID: 279548 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: New York  
Vaccinated:2007-04-24
Onset:2007-04-24
   Days after vaccination:0
Submitted: 2007-05-14
   Days after onset:20
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. - / UNK UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0384U / UNK UN / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Loss of consciousness
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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0704USA05449

Write-up: Information has been received from a nurse, via a company representative, concerning a female patient, who on 24-APR-2007 was vaccinated with a dose of Gardasil (Lot #657617/0384U). Concomitant therapy may have included Varivax, MMR II and Vaqta. the nurse reported that "after receiving Gardasil, the patient passed out." The nurse confirmed that the patient had recovered on the same day, 24-APR-2007. The patient sought unspecified medical attention. Additional information has been requested. 07/06/07 This is in follow-up to report(s) previously submitted on 5/14/2007. Initial and follow up information has been received from a nurse, concerning a female patient, who on 24-APR-2007 was vaccinated with a dose of GARDASIL (Lot #657617/0384U). Concomitant therapy may have included VARIVAX (MSD), MMR II (MSD) and VAQTA (MSD). The nurse reported that "after receiving (GARDASIL), the patient passed out". The nurse confirmed that the patient had recovered on the same day, 24-APR-2007, and added that the patient had no additional complaints. The patient sought unspecified medical attention. No further information is expected.


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