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This is VAERS ID 281574

Case Details

VAERS ID: 281574 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Florida  
Vaccinated:2007-06-13
Onset:2007-06-13
   Days after vaccination:0
Submitted: 2007-06-13
   Days after onset:0
Entered: 2007-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB114AN / 2 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 1 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt given HPV vaccine at 11:35 at 11:40 began to give Hep A vaccine, at beginning of administration client lost consciencousness. VS were as follows BP 110/70, pulse 74 Resp 20, client awoke independantly. EMT''s had been called and responded by 11:44, benedryl 50mg given per MD order. Client recovered and she and her mother declined transport to Emergency room.


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