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This is VAERS ID 284145

Case Details

VAERS ID: 284145 (history)  
Age: 14.0  
Gender: Female  
Location: New York  
Vaccinated:2007-05-01
Onset:2007-05-01
   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
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0387U / 1 UN / UN

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
Died? No
Permanent Disability? No
Recovered? Yes
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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