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This is VAERS ID 282901

Case Details

VAERS ID: 282901 (history)  
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 / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2235AA / 0 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS C2610AA / 0 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
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: Cough x 5 days
Preexisting Conditions: none
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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