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This is VAERS ID 281699

Case Details

VAERS ID: 281699 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Arizona  
Vaccinated:2007-06-14
Onset:2007-06-14
   Days after vaccination:0
Submitted: 2007-06-14
   Days after onset:0
Entered: 2007-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB149AA / 1 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / 1 RA / IM

Administered by: Military       Purchased by: Military
Symptoms: Cold sweat, Convulsion, Hypotonia, Loss of consciousness, Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (narrow), Generalised convulsive seizures following immunisation (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: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt was given two shots and immediately after administered patient became pale, limp and clammy. Patient passed out and began to have seizure activity for a few seconds. Pt regained consciousness and her vital signs were taken and were within normal range.


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