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This is VAERS ID 284137

Case Details

VAERS ID: 284137 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2007-05-09
Onset:2007-05-09
   Days after vaccination:0
Submitted: 2007-06-14
   Days after onset:36
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Private       Purchased by: Other
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:
CDC Split Type: WAES0705USA03181

Write-up: Information has been received from a physician concerning a 14 year old female who on 09-MAY-2007 was vaccinated with the first dose of Gardasil. Concomitant medication was not reported. On 09-MAY-2007 after the patient received her first dose of Gardasil, she "passed out". Subsequently on an unspecified date, the patient recovered from "passed out". Additional information has been requested.


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