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This is VAERS ID 340357

Case Details

VAERS ID: 340357 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Florida  
   Days after vaccination:6
Submitted: 2009-02-13
   Days after onset:22
Entered: 2009-02-23
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Private
Symptoms: Asthenia, Bronchitis, Electrocardiogram normal, Influenza like illness, Loss of consciousness, Malaise, Mydriasis, Pain, Pallor, Pyrexia, Tooth injury
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), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: not at time of vaccination
Current Illness: None
Preexisting Conditions: allergic to Amoxicillin
Diagnostic Lab Data: EKG, normal; Chest X-ray, showed bronchitis 3/16/09-records received-WBC 3.2, Hgb 14.9, neutrophils elevated 77.8, lymphocytes decreased 15.4, glucose 110. Chest x-ray normal.
CDC Split Type:

Write-up: Patient received her 1st GARDASIL shot on 1-16-09. She received no other shots and was on no medication. On 1-20-09, patient woke up with flu-like symptoms fever, upper respiratory congestion, body aches, and weakness. On 1-22-09, patient was treated at urgent care for her flu-like symptoms and bronchitis. She was given a 1st dose of Azithromycin, PREDNISONE and MUCINEX mid-morning. After sleeping for 2 1/2-3hours, patient got up, sat down to eat felt ill, got up, and passed out, hitting her two front teeth and severing them. She went by ambulance to hospital ER, although she regained consciousness right away, her skin was a strange white color and her pupils were dilated. She has had no other problems since her ER treatment, but her two front teeth had to be replaced with crowns. 3/16/09-ED records received for DOS 1/22/08-presented with C/O lightheadness, syncope, nausea, felt faint, brief loss of consciousness. Abrasions on inner lips, oral laceration, suturing required. Dental injury. Impression: syncope.

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