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This is VAERS ID 280449

Case Details

VAERS ID: 280449 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: Unknown  
Vaccinated:2007-05-29
Onset:2007-05-29
   Days after vaccination:0
Submitted: 2007-06-04
   Days after onset:6
Entered: 2007-06-05
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0246U / 2 RA / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0522U / UNK LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2277AA / UNK RA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0455U / 2 LA / UN

Administered by: Private       Purchased by: Unknown
Symptoms: Blood pressure decreased, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? Yes
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: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: After few moments of receiving multiple vax and Gardasil, patient had a syncope, blood pressure dropped. She recovered. 06/06/07-records received. Vaccine record documents on 5/30/07 Gardasil lot# 0522U, Varicella Lot #0455U, Menactra lot#U2277AA, Hepatitis A 2 lot#0246U. After vaccination patien left room and had loss of consciousness for 10 seconds. BP 88/54. Felt better after resting. Walked out of office with mother


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