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This is VAERS ID 282769

Case Details

VAERS ID: 282769 (history)  
Form: Version 1.0  
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 / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2234AA / 1 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C264AA / 1 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
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: None
Preexisting Conditions: None
Allergies:
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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