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This is VAERS ID 280849

Case Details

VAERS ID: 280849 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Arizona  
Vaccinated:2007-06-01
Onset:2007-06-01
   Days after vaccination:0
Submitted: 2007-06-01
   Days after onset:0
Entered: 2007-06-07
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1280F / 1 LA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1424F / 1 RA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2115AA / 1 RA / -
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B013AA / 1 LA / -

Administered by: Private       Purchased by: Public
Symptoms: Electrocardiogram, Fall, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Recurrent syncope episodes
Allergies:
Diagnostic Lab Data: EKG
CDC Split Type:

Write-up: After giving last immunization. Pt was asked how she felt fine. 2-3 min later asked her again, she said fine. She then fell back on the bed and fainted. Doctor called into the room to examine patient. Pt reacted 2-3 min later.


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