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This is VAERS ID 283785

Case Details

VAERS ID: 283785 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: California  
Vaccinated:2007-05-02
Onset:2007-05-02
   Days after vaccination:0
Submitted: 2007-06-14
   Days after onset:43
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / UN

Administered by: Private       Purchased by: Private
Symptoms: Loss of consciousness
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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0705USA01610

Write-up: Information has been received from a nurse concerning a 13 year old female who on 02-MAY-2007 was vaccinated with the first dose of Gardasil. Ten minutes after receiving the vaccination, the patient passed out. Subsequently, the patient recovered on 02-MAY-2007 and was noted to be fine. Additional information has been requested. 07/08/2008 Initial and follow up information has been received from a nurse concerning a 13 year old female student who on 02-MAY-2007 was vaccinated with the first dose of GARDASIL. Ten minutes after receiving the vaccination, the patient passed out. Subsequently, the patient recovered on 02-MAY-2007 and was noted to be fine. In follow up information from the doctor''s office it was reported that patient felt very faint on 03-MAY-2008 (previously reported as patient passed out on 02-MAY-2008). She recovered on the same day. Additional information is not expected.


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