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This is VAERS ID 319810

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

319810
VAERS Form:
Age:15.0
Gender:Female
Location:Illinois
Vaccinated:2007-08-06
Onset:2007-09-20
Submitted:2008-07-18
Entered:2008-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0012U / 2 UN / UN

Administered by: Other      Purchased by: Unknown
Symptoms: Convulsion, Death, Syncope

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2007-09-20
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up:Information has been received from a certified medical assistant concerning a 14 year old female who was vaccinated with a first dose of GARDASIL and experienced syncope. She was taken to an emergency room and released. The patient was vaccinated with a"second dose of GARDASIL (unspecified time). Subsequently, the patient experienced her first seizure (unspecified time) and was taken to the emergency room (no further details provided). The patient was vaccinated with a third dose of GARDASIL at 15 year


Changed on 12/8/2009

319810 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Illinois
Vaccinated:2007-08-06
Onset:2007-09-20
Submitted:2008-07-18
Entered:2008-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0012U / 2 UN / UN

Administered by: Other      Purchased by: Unknown Other
Symptoms: Cardiac arrest, Convulsion, Death, Fall, Mydriasis, Pulmonary congestion, Pulmonary oedema, Pulse absent, Pupil fixed, Respiration abnormal, Syncope, Unresponsive to stimuli, Ventricular fibrillation, Toxicologic test normal, Visceral congestion

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2007-09-20
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown Unknown. PMH: 1 prior seizure 8/2007. 4/28/09 Additional records received from PCP at CDC''s request. Pt in for OV 1/30/07 with c/o allergy sx and requesting HPV#1-given 0012U. Returned 3/22/07 for HPV#2-given 1427F with Boostrix AC52B012AA. Mild URI 4/25/07. OV 6/12/07 in F/U to ER visit for seizure on 6/11/07. Syncope noted. Sent for tests. OV 6/28/07 Echo and blood work repor
Allergies:
Diagnostic Lab Data: Unknown Unknown. Labs and Diagnostics: Tox screen (-).
CDC 'Split Type': (blank) WAES0807USA02139

Write-up:Information has been received from a certified medical assistant concerning a 14 year old female who was vaccinated with a first dose of GARDASIL and experienced syncope. She was taken to an emergency room and released. The patient was vaccinated with a"second a second dose of GARDASIL (unspecified time). Subsequently, the patient experienced her first seizure (unspecified time) and was taken to the emergency room (no further details provided). The patient was vaccinated with a third dose of GARDASIL at 15 year years old. Approximately 27-JUN-2008, two weeks after the third dose, the patient developed a complication. She was taken to the hospital by ambulance but passed away during the transport from an unknown cause. The physician has asked the mother for the autopsy report. The reporting medical assistant considered the syncope, seizure and "a complication" were considered to be immediately life-threatening and disabling. Additional information has been requested. 2/13/09 Autopsy report received. COD: Seizure Disorder. Summary Diagnoses: Clinical history of seizure disorder. Pulmonary congestion and edema. Passive visceral congestion. 2/20/2009 ER received from CDC. Pt presented to ER via EMS following witnessed seizure activity with fall from standing. Upon EMS arrival pt had agonal respirations and was pulseless in V-fib at 650. Upon arrival in ER unresponsive, pupils fixed and dilated, no cardiac activity. Resuscitation unsuccessful and pt expired.


Changed on 4/14/2017

319810 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Illinois
Vaccinated:2007-08-06
Onset:2007-09-20
Submitted:2008-07-18
Entered:2008-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0012U / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Cardiac arrest, Convulsion, Death, Fall, Mydriasis, Pulmonary congestion, Pulmonary oedema, Pulse absent, Pupil fixed, Respiration abnormal, Syncope, Unresponsive to stimuli, Ventricular fibrillation, Toxicologic test normal, Visceral congestion

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2007-09-20
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: 1 prior seizure 8/2007. 4/28/09 Additional records received from PCP at CDC''s request. Pt in for OV 1/30/07 with c/o allergy sx and requesting HPV#1-given 0012U. Returned 3/22/07 for HPV#2-given 1427F with Boostrix AC52B012AA. Mild URI 4/25/07. OV 6/12/07 in F/U to ER visit for seizure on 6/11/07. Syncope noted. Sent for tests. OV 6/28/07 Echo and blood work repor reportedly WNL. Syncope again noted. PE WNL. OV 7/5/07 EEG normal. EIA? Retuned 8/6/07 for HPV#3 given 0012U. PFTs reportedly normal.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Tox screen (-).
CDC 'Split Type': WAES0807USA02139

Write-up:Information has been received from a certified medical assistant concerning a 14 year old female who was vaccinated with a first dose of GARDASIL and experienced syncope. She was taken to an emergency room and released. The patient was vaccinated with a second dose of GARDASIL (unspecified time). Subsequently, the patient experienced her first seizure (unspecified time) and was taken to the emergency room (no further details provided). The patient was vaccinated with a third dose of GARDASIL at 15 years old. Approximately 27-JUN-2008, two weeks after the third dose, the patient developed a complication. She was taken to the hospital by ambulance but passed away during the transport from an unknown cause. The physician has asked the mother for the autopsy report. The reporting medical assistant considered the syncope, seizure and "a complication" were considered to be immediately life-threatening and disabling. Additional information has been requested. 2/13/09 Autopsy report received. COD: Seizure Disorder. Summary Diagnoses: Clinical history of seizure disorder. Pulmonary congestion and edema. Passive visceral congestion. 2/20/2009 ER received from CDC. Pt presented to ER via EMS following witnessed seizure activity with fall from standing. Upon EMS arrival pt had agonal respirations and was pulseless in V-fib at 650. Upon arrival in ER unresponsive, pupils fixed and dilated, no cardiac activity. Resuscitation unsuccessful and pt expired.


Changed on 9/14/2017

319810 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:Illinois
Vaccinated:2007-08-06
Onset:2007-09-20
Submitted:2008-07-18
Entered:2008-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0012U / 2 3 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Convulsion, Death, Syncope

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2007-09-20
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown. PMH: 1 prior seizure 8/2007. 4/28/09 Additional records received from PCP at CDC''s request. Pt in for OV 1/30/07 with c/o allergy sx and requesting HPV#1-given 0012U. Returned 3/22/07 for HPV#2-given 1427F with Boostrix AC52B012AA. Mild URI 4/25/07. OV 6/12/07 in F/U to ER visit for seizure on 6/11/07. Syncope noted. Sent for tests. OV 6/28/07 Echo and blood work reportedly WNL. Syncope again noted. PE WNL. OV 7/5/07 EEG normal. EIA? Retuned 8/6/07 for HPV#3 given 0012U. PFTs reportedly normal.
Allergies:
Diagnostic Lab Data: Unknown. Labs and Diagnostics: Tox screen (-).
CDC 'Split Type': WAES0807USA02139

Write-up:Information has been received from a certified medical assistant concerning a 14 year old female who was vaccinated with a first dose of GARDASIL and experienced syncope. She was taken to an emergency room and released. The patient was vaccinated with a second dose of GARDASIL (unspecified time). Subsequently, the patient experienced her first seizure (unspecified time) and was taken to the emergency room (no further details provided). The patient was vaccinated with a third dose of GARDASIL at 15 years old. Approximately 27-JUN-2008, two weeks after the third dose, the patient developed a complication. She was taken to the hospital by ambulance but passed away during the transport from an unknown cause. The physician has asked the mother for the autopsy report. The reporting medical assistant considered the syncope, seizure and "a complication" were considered to be immediately life-threatening and disabling. Additional information has been requested. 2/13/09 Autopsy report received. COD: Seizure Disorder. Summary Diagnoses: Clinical history of seizure disorder. Pulmonary congestion and edema. Passive visceral congestion. 2/20/2009 ER received from CDC. Pt presented to ER via EMS following witnessed seizure activity with fall from standing. Upon EMS arrival pt had agonal respirations and was pulseless in V-fib at 650. Upon arrival in ER unresponsive, pupils fixed and dilated, no cardiac activity. Resuscitation unsuccessful and pt expired.


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