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This is VAERS ID 282602

Case Details

VAERS ID: 282602 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: Ohio  
Vaccinated:2007-06-15
Onset:2007-06-15
   Days after vaccination:0
Submitted: 2007-06-15
   Days after onset:0
Entered: 2007-06-21
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. AHAVB141AA / 1 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1427F / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0950F / 2 LA / SC
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2225AA / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2457AA / 5 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Dizziness, Fall, Hyperhidrosis, Syncope, Syncope vasovagal
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (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: none
Current Illness: none
Preexisting Conditions: None Known of patient and younger sib. interpreted for mom who did not speak english.
Allergies:
Diagnostic Lab Data: Dr called patients response a Vasovagal fainting episode
CDC Split Type:

Write-up: Pt received 5 vaccines was sitting in waiting room after injections, with her family. Approximately 5 minutes later mom yelled for help. Patient was lying on floor face down. She had been feeling dizzy and fainted. BP 106/60, P 76 diaphoretic. Recovered after approx 5 minutes.


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