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This is VAERS ID 513736

Case Details

VAERS ID: 513736 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: Idaho  
   Days after vaccination:17
Submitted: 2013-11-19
   Days after onset:68
Entered: 2013-11-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H017698 / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Activities of daily living impaired, Blood glucose normal, Chest X-ray normal, Dizziness, Dyspnoea, Electrocardiogram normal, Full blood count normal, Headache, Loss of consciousness, Nausea, Urine analysis normal
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (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? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: CBC = normal; Glucose levels = normal; EKG = normal; Chest X-ray = normal; B.P. = normal to low; No fever; U/A = normal
CDC Split Type:

Write-up: 2 weeks after immunization blacked out during volleyball game and went to ER. Ongoing symptoms of dizziness, passing out, trouble breathing, nausea and headaches. Missing school and working with doctors to relieve symptoms. After 90 days, still having reactions.

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