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This is VAERS ID 282567

Case Details

VAERS ID: 282567 (history)  
Age: 21.0  
Gender: Female  
Location: New York  
Vaccinated:2007-02-15
Onset:2007-02-16
   Days after vaccination:1
Submitted: 2007-03-28
   Days after onset:39
Entered: 2007-06-18
   Days after submission:82
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0954F / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2644A / 0 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Dizziness, 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), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prednisone
Current Illness:
Preexisting Conditions: Autoimmune hepatitis. She did not have any illness at the time of the vaccinations.
Diagnostic Lab Data:
CDC Split Type: 200700558

Write-up: A 21 year old, female patient with a history of autoimmune hepatitis, became light headed and passed out twice, about 20 hours after she received Adacel (lot number C2644AA) intramuscularly in the left deltoid and Gardasil (lot number 0954F) intramuscularly in the right arm, on 15 February 2007. She did not have any illness at the time of the vaccinations. She fully recovered and is stable. Follow-up information received on 26 March 2007. The patient had no illness at the time of vaccination and had received no other vaccinations within four weeks of the 15 February 2007 immunization. The event required a doctor visit. No relevant diagnostic testing was performed.


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