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This is VAERS ID 280849

Case Details

VAERS ID: 280849 (history)  
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 / 0 LA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1424F / 0 RA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2115AA / 0 RA / -
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B013AA / 0 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
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Recurrent syncope episodes
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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