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This is VAERS ID 269192

Case Details

VAERS ID: 269192 (history)  
Age: 16.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2006-11-07
Onset:2006-11-07
   Days after vaccination:0
Submitted: 2007-04-06
   Days after onset:149
Entered: 2006-12-18
   Days after submission:108
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0688F / 0 UN / IM

Administered by: Private       Purchased by: Other
Symptoms: Fall, Laceration, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: Anorexia
Preexisting Conditions:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0611USA04002

Write-up: Information has been received from a physician concerning a 14 year old female who on an unspecified date was vaccinated with Gardasil (yeast). It was reported that the patient was sitting on a bench and when the personnel left the room, the patient apparently fainted and ended up falling off bench. It was reported that it was unsure if the patient had broken her nose but there was blood. At the time of this report, the outcome of the events were unknown. The physician feels that the patient "might be anorexic and had not had anything to eat all day hence the fainting". No further information is available. This is in follow-up to report (s) previously submitted on 12/14/2006. Initial and follow up information has been received from a physician concerning a 16 year old (previously reported as 14 year old) white female. On 07-NOV-2006, at 10:02 AM, the patient was vaccinated intramuscularly with the first dose of GARDASIL (Lot # 653735/0688F). On 07-NOV-2006, at 10:03 AM, the patient was sitting on a bench and when the personnel left the room, the patient fainted and ended up falling off the bench. It was reported that the patient had hit her nose when she fell and developed a small laceration (previously reported that it was unsure if the patient had broken her nose but there was blood). The patient came to quickly with no other sequelae. It was reported that the patient had not eaten breakfast. On 07-NOV-2006, the patient had recovered from the events. The physician feels that the patient "might be anorexic and had not had anything to eat all day hence the fainting". No further information is available.


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