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This is VAERS ID 284145

Case Details

VAERS ID: 284145 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: New York  
   Days after vaccination:0
Submitted: 2007-06-14
   Days after onset:44
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Other
Symptoms: Loss of consciousness, Muscle twitching, Paraesthesia
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (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: Reaction to sulphite; Milk allergy; Sulfonamide; Drug hypersensitivity; Polycystic ovarian syndrome
Preexisting Conditions: Unknown
Diagnostic Lab Data: Total heartbeat count, 05/01/2007, 46; Total heartbeat count, 05/01/07, 68.
CDC Split Type: WAES0705USA03385

Write-up: Information has been received from a physician concerning a 14 year old female who was vaccinated with a second dose of Gardasil. Subsequently the patient experienced tingling in her nose, passed out and little twitching. Unspecified medical attention was sought. It was reported that the patient recovered 2 minutes after the vaccine was administered. There were no diagnostic or laboratory tests performed. Additional information has been requested. This is in follow-up to reports previously submitted on 6/14/2007. Initial and follow-up information has been received from a physician concerning a 14 year old female stundent with reaction to sulphite, milk allergy, sulfonamide allergy, drug hypersensitivity to CECLOR and polycystic ovarin syndrome who on 01-MAY-2007 was vaccinated, into left arm, with a second dose og GARDASIL. On 01-MAY-2007, within 1 minute, the patient recovered from all symptoms and her heart rate was 68. There were no diagnostic or laboratory test performed. No further information is available.

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