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This is VAERS ID 314847

Case Details

VAERS ID:314847 (history)  Vaccinated:2007-08-29
Age:9.0  Onset:2007-08-29, Days after vaccination: 0
Gender:Female  Submitted:2008-05-16, Days after onset: 261
Location:Unknown  Entered:2008-05-23, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0708USA05426
Administered by: Other     Purchased by: Other
Symptoms: Immediate post-injection reaction, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)
Write-up: Information has been received from a health professional concerning a 9 year old female with no pertinent medical history, drug reactions or allergies who on 29-AUG-2007 was vaccinated with a "booster shot" of varicella virus vaccine live (Oka/Merck) (Lot # 658413/1025U). Concomitant therapy included human papillomavirus vaccine (GARDASIL). On 29-AUG-2007 the patient passed out immediately after receiving varicella virus vaccine live (Oka/Merck). There were no lab diagnostic studies performed. Unspecified medical attention was sought. There was no product quality complaint. Additional information has been requested.

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