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This is VAERS ID 284537

Case Details

VAERS ID: 284537 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: Arkansas  
   Days after vaccination:0
Submitted: 2007-06-14
   Days after onset:19
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Dizziness, Hypotonia, Loss of consciousness, Malaise
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), 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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data:
CDC Split Type: WAES0705USA05737

Write-up: Information has been received from a nurse concerning her 14 year old daughter who on 26-APR-2007 was vaccinated IM with 0.5 ml of Gardasil. On 26-MAY-2007 after she was vaccinated, the patient experienced dizziness and passed out. The patient sought unspecified medical attention. Subsequently, the patient recovered from the events. Additional information has been requested. In follow-up it was reported by the licensed practical nurse (LPN), concerning her white, 14 year old, student daughter, whose reported weight was 123 pounds and whose reported height was 65.2 inches who on 26-May-2007 was vaccinated intramuscularly (IM) with 0.5 ml of Gardasil (lot #657622/03880). It was reported that on 25-May-2007 after the patient received the Gardasil, the patient said that she didn''t feel very well and everything was black. She was assisted to a lying position and while she was getting ready to lie down she went limp and passed out for 3 minutes. Her name was called 2-3 times and she came "to". I t was reported thst the patient recovered. Additional information has been requested.

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