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This is VAERS ID 284237

Case Details

VAERS ID: 284237 (history)  
Age: 16.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2007-07-10
Onset:2007-07-10
   Days after vaccination:0
Submitted: 2007-07-10
   Days after onset:0
Entered: 2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0387U / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2365AA / 0 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B018AD / 0 RA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Convulsion, Fall, Injury, Syncope vasovagal
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. had a vasovagal response to Gardasil vaccine in the office, falling onto the floor and hitting her face. Pt had seizure activity, per her mother. Pt was moved to a chair, was sitting and talking and went on to have further seizure acitivty and 911 was called. we monitered the pt. until medics arrived and she was transported to the ED.


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