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This is VAERS ID 282180

Case Details

VAERS ID: 282180 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2007-06-18
Onset:2007-06-18
   Days after vaccination:0
Submitted: 2007-06-18
   Days after onset:0
Entered: 2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0388U / 1 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2632AA / 1 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), 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:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: ADMIN HPV AND TDAP VACCINE, WITHIN ONE MIN OF ADMIN CHILD FAINTED INTO FATHERS ARMS, PT OBSERVED FOR 15 ADDITIONAL MIN WITH NO PROBLEMS. VITALS WNL. This is in follo-up to report (s) previously submitted on 10/12/2007. Information has been received from a registered nurse concerning a 15 year old female with no medical history or allergies who on 18-JUN-2007 was vaccinated IM into the left deltoid with a first 0.5 ml dose of GARDASIL (lot# 657622/0388U). Concomitant medication given IM into the left deltoid included the first dose of ADACEL (batch c2632AA). Approximately one minute after getting the vaccine the patient fainted for a few seconds. The patient was observed in the office for 15 minutes and fully recovered. Unspecified medical attention was sought and no treatment was needed. No diagnostic laboratory studies were performed. It was reported that the patient was vaccinated with a second dose of the vaccine on 20-AUG-2007 amd experienced no events. No quality complaint was involved. Additional information is not expected.


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