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This is VAERS ID 279642

Case Details

VAERS ID: 279642 (history)  
Age: 16.0  
Gender: Female  
Location: Mississippi  
   Days after vaccination:0
Submitted: 2007-05-14
   Days after onset:18
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Other
Symptoms: No reaction on previous exposure to drug, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ZYRTEC, hormonal contraceptives, SINGULAIR
Current Illness: Asthma, drug hypersensitivity; Hypoglycemia; Syncope; Dizziness
Preexisting Conditions: Lightheadedness
Diagnostic Lab Data: Blood pressure, 04/26/2007, 90/50; vital sign, 04/26/07
CDC Split Type: WAES0704USA06655

Write-up: Information has been received from a nurse concerning a 16 year old female student, with asthma and an allergy to cefaclor (Ceclor), per her parents she had hypoglycemia with dizziness and syncope, a recent history of lightheadedness in school, who on 30-OCT-2006 was vaccinated IM with a first dose of Gardasil. Concomitant therapy included Zyrtec, Singulair and hormonal contraceptives (unspecified). On 21-DEC-2006, the second vaccination with Gardasil was administered. The patient had no adverse event with the first or second vaccination. On 26-APR-2007, late PM, the patient''s vitals were taken (results not reported) and then she was vaccinated IM into the deltoid with a third dose of GARDASIL (lot # 657006/0188U). Concomitant therapy included ZYRTEC, SINGULAIR and hormonal contraceptives (unspecified) Ten minutes later, the patient fainted in the waiting room. Her blood pressure was 90/50. She had not eaten that afternoon before the vaccination. Subsequently, the patient recovered. Additional information has been requested. Additional information is not expected.

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