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This is VAERS ID 284288

Case Details

VAERS ID: 284288 (history)  
Form: Version 1.0  
Age: 17.0  
Gender: Female  
Location: Michigan  
Vaccinated:2007-07-11
Onset:2007-07-11
   Days after vaccination:0
Submitted: 2007-07-11
   Days after onset:0
Entered: 2007-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. C2638AA / UNK - / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR AVU2277AA / UNK - / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR 1208F / UNK - / IM

Administered by: Public       Purchased by: Public
Symptoms: Cold sweat, Dyskinesia, Gaze palsy, Immediate post-injection reaction, Pallor, Peripheral coldness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dyskinesia (narrow), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

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

Write-up: Immed. after receiving injection client eyes rolled and tongue protruded (siezure like activity)became VERY pale and fainted. Skin was cold and clammy. Took several minutes for her to come around. Client had 2 injection prior to getting the HPV.


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