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This is VAERS ID 279642

Case Details

VAERS ID: 279642 (history)  
Form: Version 1.0  
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
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: 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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