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This is VAERS ID 284530

Case Details

VAERS ID: 284530 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: Washington  
Vaccinated:2007-05-16
Onset:2007-05-16
   Days after vaccination:0
Submitted: 2007-06-14
   Days after onset:29
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. - / UNK UN / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0171U / 1 UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / UNK UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (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: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0705USA05712

Write-up: Information has been received from a physician concerning a 12 year old female who was vaccinated with Gardasil. Concomitant therapy included DPT and Menactra. Subsequently the patient experienced dizziness and a lightheaded woozy feeling after receiving therapy with Gardasil. Subsequently, the patient recovered from dizziness and lightheaded woozy feeling. Additional information has been requested. 10/08/07 This is in follow-up to report(s) previously submitted on 6/14/2007. Initial information has been received from a physician and a licensed practical nurse concerning a 11 year old female who on 16-MAY-2007 was vaccinated with a first dose of GARDASIL (lot # 655620/0171U). On 16-MAY-2007, concomitant therapy included IM dose of DTP, IM dose of MENACTRA and IM dose of hepatitis A virus vaccine (manufacturer unknown). On 16-MAY-2007, experienced dizziness lasting about 15 minutes. On 16-MAY-2007, the patient recovered from dizziness and the lightheaded woozy feeling. Additional information is not expected.


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