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This is VAERS ID 282901

Case Details

VAERS ID: 282901 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: Oregon  
Vaccinated:2007-06-22
Onset:2007-06-22
   Days after vaccination:0
Submitted: 2007-06-25
   Days after onset:3
Entered: 2007-06-26
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0389U / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2235AA / 1 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS C2610AA / 1 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Computerised tomogram, Fall, Head injury, Loss of consciousness, Somnolence, Syncope
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), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: none
Current Illness: Cough x 5 days
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: CT of the head
CDC Split Type:

Write-up: Approx 5 minutes after receiving vaccines which included Tdap, HPV#1 and Menactra, pt had syncopal episode, falling to the floor and hitting her head. She was unconscious for approx 10-15 seconds, then groggy but oriented x 3. She was unable to remember the day''s events and kept asking the same questions repeatedly. Was observed in outpatient clinic x 2 hours with no improvement. Transported via ambulance to ER, CT of head was normal, was observed 2 more hours and discharged home.


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