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This is VAERS ID 307011

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID: 307011 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Georgia  
Vaccinated:2008-03-08
Onset:2008-03-08
   Days after vaccination:0
Submitted: 2008-03-13
   Days after onset:4
Entered: 2008-03-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB217BA / UNK LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1508U / 2 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Pain in extremity, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (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: Fainting~ ()~~0.00~In Patient
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Administered HPV (Gardasil) vaccine #1 in child''s left deltoid. Patient fainted. I put ammonia under her nose. She woke up but was very pale and complained of her legs hurting. She then put her head between her legs and she began to feel better.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170914&IDNUMBER=307011


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