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This is VAERS ID 282769

Case Details

VAERS ID: 282769 (history)  
Age: 17.0  
Gender: Female  
Location: Virginia  
Vaccinated:2007-06-18
Onset:2007-06-18
   Days after vaccination:0
Submitted: 2007-06-22
   Days after onset:4
Entered: 2007-06-25
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0384U / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2234AA / 0 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C264AA / 0 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Blood pressure decreased, Dizziness, Fall, Heart rate decreased, Hyperhidrosis, Pallor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Became lightheaded, fell backwards and caught by mom. Placed on exam table where she became diaphoretic, pale, BP decrease 50/36, HR 40. Given fluids, Recovered after 15 minutes, Hct 13.5, VS stable after 1/2 hr.


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