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This is VAERS ID 283645

Case Details

VAERS ID: 283645 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: Pennsylvania  
Submitted: 2007-07-02
Entered: 2007-07-03
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Convulsion, Eye rolling, Loss of consciousness, Poor quality drug administered
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Medication errors (narrow), 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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0706USA04875

Write-up: Information has been received from a nurse concerning a 14 year old female who was vaccinated with the second dose of the Gardasil (Lot # 658094/0524U) on an unspecified date. It was reported that the patient experienced seizure like activity after receiving the vaccine. Her eyes rolled back in her head and briefly lost consciousness. The patient sought unspecified medical attention. She recovered 40 minutes after injection. The nurse also reported that the refrigerator where the vaccine was stored was "4 degrees colder than it should have been". Upon internal review, seizure-like activity was considered to be an other important medical event. This report is one of two reports from the same source. Additional information has been requested.

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