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This is VAERS ID 284017

Case Details

VAERS ID: 284017 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Illinois  
Vaccinated:2007-07-06
Onset:2007-07-06
   Days after vaccination:0
Submitted: 2007-07-06
   Days after onset:0
Entered: 2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0211U / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Loss of consciousness, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within one minute of receiving HPV vaccine, pt. had a sycopal episode, with LOC for 1-2 minutes, immediately followed by vomiting. Pt. observed for 15 min. and made complete recovery.


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