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This is VAERS ID 283126

Case Details

VAERS ID: 283126 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2007-06-22
Onset:2007-06-22
   Days after vaccination:0
Submitted: 2007-06-28
   Days after onset:6
Entered: 2007-06-29
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0524U / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Dizziness, Nausea, Skin discolouration
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within minutes of receiving Gardasil vaccine turned green and became lightheaded. After laying down for 20 minutes sat up and became nauseous. Patient able to leave after being observed for 45 minutes - 1 hour.


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