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This is VAERS ID 460438

Case Details

VAERS ID: 460438 (history)  
Form: Version 1.0  
Age: 17.0  
Sex: Male  
Location: Texas  
Vaccinated:2012-07-26
Onset:2012-07-26
   Days after vaccination:0
Submitted: 2012-07-27
   Days after onset:1
Entered: 2012-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0022AE / 1 LA / SYR

Administered by: Public       Purchased by: Public
Symptoms: Asthenia, Feeling abnormal, Pallor
SMQs:, Dementia (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. received vaccine at approximately 1:10pm on 7-26-12. Pt. reacted to the vaccine 5 minutes later and was feeling dazed, pale, weak. Treatment with epinephrine .2mL. Pt. recovered 20 minutes after injection of epinephrine. Site was the deltoid of the left arm.


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