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This is VAERS ID 282912

Case Details

VAERS ID: 282912 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: New York  
   Days after vaccination:0
Submitted: 2007-06-26
   Days after onset:10
Entered: 2007-06-27
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0523U / 2 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Grand mal convulsion, Oxygen supplementation, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (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: Syncope vasovagal; Drug hypersensitivity
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0706USA03141

Write-up: Information has been received from a physician and a registered nurse concerning a 15 year old female with a drug sensitivity to SEPTRA and a history of seeing a neurologist and cardiologist for neurocardio syncope (Vasovagal) who on 26-MAR-2007 was vaccinated IM with a 0.5 ml first dose of Gardasil. On approximately, 16-JUN-2007 the patient was vaccinated IM with a 0.5 ml second dose of Gardasil (lot # 657868/0523U). There was no concomitant medications. On 16-JUN-2007, while in the physicians office, the patient fainted and then had a grand mal seizure. The patient was given oxygen. The office called for an ambulance and the patient was taken to the emergency room and released. There were no laboratory or diagnostic test performed. On 16-JUN-2007, the patient recovered from fainting and the grand mal seizure. On 18-JUN-2007, the patient was seen in the physicians office and was referred to a neurologist. Upon internal review, grand mal seizure was considered to be an other important medical event. The registered nurse is requesting a lot check. Additional information has been requested.

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