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This is VAERS ID 284865

Case Details

VAERS ID: 284865 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2007-07-02
Onset:2007-07-02
   Days after vaccination:0
Submitted: 2007-07-06
   Days after onset:4
Entered: 2007-07-17
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0525U / 2 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0716U / 2 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Dizziness, Hyperhidrosis, Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (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:
Current Illness: None
Preexisting Conditions: Amoxicillin allergy
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt appeared very pale and diaphoretic "feel like I''m going to pass out"-occurred 10 min after injection. VSS. Rested on side x 15 min and observed for total of 30 min.


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