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This is VAERS ID 284463

Case Details

VAERS ID: 284463 (history)  
Form: Version 1.0  
Age: 18.0  
Gender: Female  
Location: Kansas  
Vaccinated:2007-03-21
Onset:2007-03-21
   Days after vaccination:0
Submitted: 2007-06-14
   Days after onset:85
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0014U / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2228AA / 1 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS C2638AA / 1 LA / IM

Administered by: Public       Purchased by: Private
Symptoms: Fall, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), 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:
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES0705USA04199

Write-up: Information has been received from a registered nurse concerning an 18 year old female who on 21-MAR-2007 at 3:30 pm was vaccinated with 0.5 ml of the first dose of Gardasil (Lot #653736/0014U) in right deltoid. Concomitant therapy on 21-MAR-2007 at 3:30 pm included MENACTRA (lot # U2228AA) in right deltoid, and BOOSTRIX (lot # C2638AA) in left deltoid. On 21-MAR-2007, at 3:30 pm (previously reported as 10 to 15 minutes after vaccination) the patient experienced fainting. On 21-MAR-2007, the patient recovered from fainting. Additional information is not expected. 10/08/07 This is in follow-up to report(s) previously submitted on 6/14/2007. Initial and follow-up information has been received from a registered nurse concerning an 18 year old female who on 21-MAR-2007 at 3:30 pm was vaccinated with 0.5 ml of the first dose of GARDASIL (Lot #653736/0014U) in right deltoid. Concomitant therapy on 21-MAR-2007 at 3:31 pm included MENACTRA (lot # U2228AA) in right deltoid, and at 3:32 pm included BOOSTRIX (lot # C2638AA) in left deltoid. After the injections were administered, the patient voiced no difficulties, denied discomfort, and no abnormalities in appearance were observed. The patient walked 10 yards to the front reception desk. She visited as paperwork was being completed while she stood at the counter. On 21-MAR-2007, at 3:37 pm (previously reported as 10 to 15 minutes after vaccination) the patient slid onto the floor with syncope. On 21-MAR-2007, the patient recovered from fainting. After syncope went to doctor''s office for previously scheduled appointment with no problems upon exam. A telephone call was made later to the patient later that evening with no residual effects. The patient''s mother has telephoned to schedule the patient''s second GARDASIL injection. Additional information is not expected.


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