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This is VAERS ID 280486

Case Details

VAERS ID: 280486 (history)  
Form: Version 1.0  
Age: 21.0  
Gender: Female  
Location: Tennessee  
Vaccinated:2007-06-05
Onset:2007-06-05
   Days after vaccination:0
Submitted: 2007-06-05
   Days after onset:0
Entered: 2007-06-06
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB11BAB / 2 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0212U / 1 LA / IM
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR U1953AA / 2 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Immediate post-injection reaction, Nausea, Presyncope
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1. (L) arm Hep A then Td 2. (L) arm Gardasil Immediate onset of nausea and pre syncopal symptoms, BP 80/60 Improved within 10 min lying down


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