National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 284558

Case Details

VAERS ID: 284558 (history)  
Age: 12.0  
Gender: Female  
Location: Texas  
Vaccinated:2007-02-09
Onset:2007-02-09
   Days after vaccination:0
Submitted: 2007-06-14
   Days after onset:124
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / 0 UN / IM
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UN / UN

Administered by: Other       Purchased by: Private
Symptoms: Head injury, Heart rate normal, Musculoskeletal stiffness, Neurological examination, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown; Vaginal delivery
Diagnostic Lab Data: Unknown; neurological examination, 02/09/07, Patient alert to name, place and responding appropriately to questions; vital sign, 02/09/07, blood pressure 90/60 heart rate 90
CDC Split Type: WAES0706USA00040

Write-up: Information has been received from a licensed practical nurse concerning a female patient who was vaccinated with a first dose of Gardasil. Concomitant therapy given on the same day included a dose of Varivax and a dose of Tdap on the same day. It was reported that Gardasil was the last in that series of vaccines the patient received. Subsequently, the patient fainted. Unspecified medical attention was sought. On an unknown date, the patient recovered. No product quality complaint was involved. Additional information has been requested. This is in follow-up to report(s) previously submitted on 6/14/2007. Information has been received from a registered nurse concerning a 12 year old female patient with a history of vaginal birth (no complication) who on 09-FEB-2007 at 09:54 was vaccinated IM into the right deltoid with a first dose of GARDASIL (Lot# 654389/0961F). Concomitant therapy given on the same day included a dose of VARIVAX and a dose of Tdap (unspecified) on the same day. It was reported that GARDASIL was the last in that series of vaccines the patient received. After immunization at 09:54, the patient stated the last shot on the right arm was painful. The patient turned pale, went back and hit her head to the wall. The patient stiffened, made some gurgling noise and had her eyes open. It was reported that the patient had a brief episode of fainting on the exam table. It lasted 1-2 seconds. The patient recovered spontaneously. Once the patient came around the patient asked "what happened?" Laboratory diagnostic studies included a "neuro" check. It was reported that the patient was alert to her name, place and was responding appropriately to questions. The patient''s vital signs included a blood pressure measurement of 90/60 and a heart rate of 90. The physician was notified, water was offered and tolerated well. The physician examined the patient. The patient walked out of the room without any difficulty. The physician presumed the experience was transient vasovagal episode. The patient was offered an appointment to return to the clinic only if the patient was up to it. At the time of this report, the patient''s outcome to the vasovagal episode, turned pale and painful right arm was unknown, however, the patient recovered from fainted. No product quality complaint was involved. Additional information is not expected.


New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=284558


Copyright © 2017 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166