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This is VAERS ID 309503

Case Details

VAERS ID: 309503 (history)  
Age: 14.0  
Gender: Female  
Location: California  
Vaccinated:2008-04-08
Onset:2008-04-08
   Days after vaccination:0
Submitted: 2008-04-14
   Days after onset:6
Entered: 2008-04-15
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
BCG: BCG (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1266U / 0 UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / - UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Hypotension, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0804USA02247

Write-up: Information has been received from a medical assistant concerning a 14 year old female who on 08-APR-2008 was vaccinated with GARDASIL (lot#659437/1266U) 0.5mL IM. Concomitant therapy included MENACTRA and "TB" vaccine (manufacturer unknown). On 08-APR-28 the patient fainted after receiving GARDASIL. The medical assistant reported that the patient was rushed to the hospital via ambulance due to severe hypotension after receiving the vaccine. At the time of reporting it was unknown if the patient had recovered. The reporter felt that syncope and severe hypotension were considered to be disabling, life threatening and an other medical event. Additional information has been requested.


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