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This is VAERS ID 284564

Case Details

VAERS ID: 284564 (history)  
Age: 15.0  
Gender: Female  
Location: New York  
Vaccinated:2007-05-30
Onset:2007-05-30
   Days after vaccination:0
Submitted: 2007-06-14
   Days after onset:15
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1426F / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / 0 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Blood pressure normal, Dizziness, Fatigue, Loss of consciousness, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: blood pressure, normal
CDC Split Type: WAES0706USA00267

Write-up: Information has been received from a physician concerning a 15 year old female with no drug allergies and no medical history, who on 30-MAY-2007 was vaccinated intramuscularly into the left arm with a first dose of Gardasil (Lot# 655205/1426F). Concomitant vaccination included a first dose of MENACTRA intramuscularly into the right arm. It was reported that "Patient experienced dizziness, vomiting, burning with injection of vaccine and lost consciousness. The patient turned very pale and began to bob up and down on her legs. Her blood pressure was taken, which was normal. The patient felt very tired and just wanted to lay down for awhile. The color returned to her face, she sat up in the chair and after approximately 15-20 minutes later she walked out of the office on her own. There were no illnesses at the time of the vaccinations. Unspecified medical attention was sought. No further information was provided. Additional information has been requested. Additional information is not expected.


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