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This is VAERS ID 284172

Case Details

VAERS ID: 284172 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Oregon  
   Days after vaccination:0
Submitted: 2007-06-14
   Days after onset:59
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Private
Symptoms: Blood pressure, Immediate post-injection reaction, 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), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: blood pressure, 04/16/07, 84/57 mmHg; blood pressure, 04/16/07, 96/54 mmHg
CDC Split Type: WAES0705USA03941

Write-up: Information has been received from a physician concerning an 11 year old female who was vaccinated with GARDASIL. It was reported that the patient passed out ''almost immediately" after receiving the vaccine. No lot number was provided. The patient sought unspecified medical attention. The patient had her blood pressure measured. It was reported that the "patient was fine". Additional information has been requested. This is in follow-up to report (s) previously submitted on 6/14/2007. In follow-up it was reported by the registered nurse concerning an 11 year old, female, with no illness a the time of the vaccination and no pre-existing allergies, birth defects, or medical conditions, who on 16-APR-2007 at 10:00 a.m., was vaccinated in the left deltoid muscle with the first dose of GARDASIL, (Lot # 657005/0314U). It was reported tht immediately after receiving the immunization the patient had a syncopal episode. The patient''s mother and the nurse caught the patient before she hit the ground. The patient was pale and diaphoratic, blood pressure was 84/57 mmHg. The patient was put in the Trendelenburg position. The patient''s blood pressure rose to 96/54 mmHg. The patient walked out after 10 minutes. It was reported that the patient recovered on 16-APR-2007. Additional information has been requested.

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