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This is VAERS ID 282646

Case Details

VAERS ID: 282646 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: Unknown  
Vaccinated:2007-06-01
Onset:2007-06-01
   Days after vaccination:0
Submitted: 2007-06-21
   Days after onset:20
Entered: 2007-06-22
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0389U / UNK - / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / UNK UN / UN
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Fluid replacement, Loss of consciousness, Oxygen supplementation
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), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0706USA02781

Write-up: Information has been received from a physician''s assistant concerning an 11 year old female who on 01-JUN-2007 was vaccinated with Gardasil (lot # 657736/0389U) (doses # unspecified) injection. Concomitant therapy included "T-Dap", and Menactra both also given on 01-JUN-2007. On 01-JUN-2007, approximately 20 minutes after receiving the Gardasil, the patient passed out in the reception area of the physician''s office. Medical attention was sought. The patient was fasting and did not have anything to eat before receiving the vaccine. The patient was treated with oxygen and fluids at the physician''s office. She was not taken to the emergency room. On 01-JUN-2007, the patient recovered. The reporting physician''s assistant felt that the event was serious because the patient was given oxygen (Other Important Medical Event). Additional information has been requested.


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