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This is VAERS ID 263210

Case Details

VAERS ID: 263210 (history)  
Age: 20.0  
Gender: Female  
Location: Pennsylvania  
   Days after vaccination:0
Submitted: 2006-09-14
   Days after onset:30
Entered: 2006-09-19
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0702F / 0 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Current Illness:
Preexisting Conditions: Penicillin allergy, drug hypersensitivity
Diagnostic Lab Data: NONE
CDC Split Type: WAES0608USA03962

Write-up: Information has been received from a nurse concerning a 20 year old female with a penicillin allergy, drug hypersensitivity to cefaclor (CECLOR) and no other pertinent medical history reported. On 15-AUG-2006, the patient was vaccinated intramuscularly with HPV rLi 6 11 16 18 VLP vaccine (yeast) (Lot#653650/0702F). Concomitant therapy included paroxetine HCL (PAXIL), bupropion HCL (WELLBUTRIN) and famotidine. It was reported that the patient became faint within 5 minutes of vaccination with HPV rLi 6 11 16 18 VLP vaccine (yeast). The patient was given a soda to drink as treatment. There were no laboratory diagnostic studies performed. On 15-AUG-2006, the patient recovered from the event. Additional information has been requested.

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