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This is VAERS ID 284775

Case Details

VAERS ID: 284775 (history)  
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 / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2181AA / 0 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B002AB / 0 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
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
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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