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This is VAERS ID 282867

Case Details

VAERS ID: 282867 (history)  
Form: Version 1.0  
Age: 18.0  
Gender: Female  
Location: Unknown  
Vaccinated:2007-06-14
Onset:2007-06-14
   Days after vaccination:0
Submitted: 2007-06-19
   Days after onset:5
Entered: 2007-06-26
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0524U / UNK UN / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Fall, Head injury, 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), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? Yes
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:
Preexisting Conditions: healthy female
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shortly after receiving Gardasil, pt blacked out and fell off exam table where she had been sitting. Her forehead struck the exam table stirrup, breaking it off, her left thigh scrapped against broken metal from stirrup and pt landed on the floor, where was found the the nurse


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