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This is VAERS ID 284775

Case Details

VAERS ID: 284775 (history)  
Form: Version 1.0  
Age: 18.0  
Gender: Female  
Location: Iowa  
Vaccinated:2007-06-26
Onset:0000-00-00
Submitted: 2007-07-16
Entered: 2007-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1427F / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2181AA / 1 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B002AB / 1 LA / IM

Administered by: Public       Purchased by: Other
Symptoms: Feeling of body temperature change, Mydriasis, Pallor, Presyncope, Staring
SMQs:, Anticholinergic syndrome (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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Pt had a near syncopal episode but with quickly placing supine was averted. Pt. observed x 30 min. and left feeling fine. Pt had not eaten. Given water and crackers.
CDC Split Type:

Write-up: HPV#1 was given and pt c/o a warm feeling, she started to stare, pupils dilated and color went pale. Pt was quickly helped to a supine position and was responsive and did not have a loss of consciousness due to quick action


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