VAERS ID: |
282867 (history) |
Form: |
Version 1.0 |
Age: |
18.0 |
Sex: |
Female |
Location: |
New York |
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 |