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This is VAERS ID 429559

Case Details

VAERS ID: 429559 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: California  
   Days after vaccination:0
Submitted: 2011-08-11
   Days after onset:10
Entered: 2011-08-12
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Balance disorder, Blood test normal, Cyanosis, Dizziness, Dyspnoea, Electrocardiogram normal, Hypotension, Oxygen saturation decreased, PO2 decreased, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Minocycline
Current Illness: Penicillin allergy; Drug hypersensitivity
Preexisting Conditions: Acne
Diagnostic Lab Data: Blood pressure, 08/01/11, slightly low; Electrocardiogram, 08/01/11, results within normal limits; Diagnostic laboratory, 08/01/11, blood work had results within normal limits; Venous blood PO(2), 08/01/11, slightly reduced
CDC Split Type: WAES1108USA00314

Write-up: Information has been received from a physician concerning a 14 year old female with allergies to amoxicillin and ZITHROMAX and a history of acne who on 01-AUG-2011 was vaccinated intramuscularly with her first dose of GARDASIL (lot# 669308/0636AA, exp date 17-AUG-2013) and on the same day was vaccinated with her second dose of VAQTA. Concomitant therapy included minocycline. The physician reported that on 01-AUG-2011 the patient became syncopal and laid down in the office for about two hours, this was able to prevent a seizure. During this time she was dizzy and wobbly with cyanosis in her hands. Her blood pressure was slightly low and she had some shortness of breath. As of evening on 01-AUG-2011, she went to the emergency room and was given fluids. Her hands still had cyanosis. The patient performed lab diagnostics and the result showed blood pressure and oxygen were slightly reduced. At the time of report, the patient did not recover. Follow-up information has been received from the physician concerning the patient. The physician reported that within 10 minutes of vaccination, the patient had syncopal episode, possible tonic-clonic movements due to that syncopal episode. The patient was alert and oriented shortly after. The patient was wobbly for 2-3 hours. The patient went to emergency room, had electrocardiography and blood work- both had results within normal limits. The patient was wobbly, unsteady the day after vaccination. The patient''s hands were still blue, but not painful, not tender. The health care professional contacted during telephone follow-up could not supply the following information: lot number for secondary suspect therapy, current recovery status, and hospital name. Syncopal, dizzy, wobbly/ unsteady, cyanosis in her hands, blood pressure low, shortness of breath and oxygen slightly reduced were considered to be other important medical events and disability or incapacity by reporter. Additional information has been requested.

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