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This is VAERS ID 284261

Case Details

VAERS ID: 284261 (history)  
Form: Version 1.0  
Age: 17.0  
Gender: Female  
Location: California  
Vaccinated:2007-01-02
Onset:2007-01-02
   Days after vaccination:0
Submitted: 2007-07-10
   Days after onset:188
Entered: 2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB129AA / 1 UN / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / 1 UN / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B014AA / 1 UN / IM

Administered by: Private       Purchased by: Private
Symptoms: Loss of consciousness, Nuclear magnetic resonance imaging brain normal, Visual disturbance
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), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra-D, Flonase, Ortho Tricyclen
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: MRI of brain was negative. Labs ordered but were not done.
CDC Split Type:

Write-up: On 4/11/2007, patient reported to me that after her 1st Gardisil vaccine on 01/02/2007, she had a "blackout" feeling as she was leaving the office. This occurred again after the 2nd Gardisil vaccine was given on 3/28/2007.She stated that "everything went black" and she could not see. She was very much alert and could hear, at that time. This episode lasted approximately 1 minute. These episodes have happened recurrently since that time, initially about once a week, now occurring less often.


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