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This is VAERS ID 279893

Case Details

VAERS ID: 279893 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: Kentucky  
   Days after vaccination:0
Submitted: 2007-05-25
   Days after onset:11
Entered: 2007-05-29
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Other
Symptoms: Blood pressure decreased, Dyskinesia, Heart rate decreased, Heart rate increased, Hypotension, Immediate post-injection reaction, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad), Dehydration (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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: blood pressure 05/14/07 72/48 mmHg, total heartbeat count 05/14/07 38bpm
CDC Split Type: WAES0705USA04237

Write-up: Information has been received from a health professional, concerning a 14 year old female student, with no known drug allergies, who on 14-MAY-2007, at 3:00pm, was vaccinated IM in the left arm, with the third dose of Gardasil (Lot #657622/0388U). There was no illness at the time of vaccination. The reporter indicated that immediately after vaccination, at 3:00pm, on 14-MAY-2007 the patient "passed out and started jerking all over the shot was given" (duration of symptoms and treatment were not reported). The patient''s vital signs included a blood pressure of 72/48mmHg, and a pulse of 38bpm. The reporter confirmed that the patient recovered on the same day, 14-MAY-2007. The reporter stated that the events of passed out, jerking all over, pulse very low and blood pressure very low, required medical intervention to prevent serious criteria, and were considered as an other important medical event. Additional information has been requested.

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