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This is VAERS ID 284261

Case Details

VAERS ID: 284261 (history)  
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 / 0 UN / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / 0 UN / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B014AA / 0 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
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra-D, Flonase, Ortho Tricyclen
Current Illness: NONE
Preexisting Conditions: NONE
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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