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This is VAERS ID 269208

Case Details

VAERS ID: 269208 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: New York  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2006-12-14
Entered: 2006-12-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK - / -

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
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: phobia
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0611USA04906

Write-up: Information has been received from a physician concerning a female who was "shot phobic" who on an unspecified date was vaccinated with Gardasil (yeast) (0.5ml). Subsequently, following vaccination, the patient fainted. Unspecified medical attention was sought. The patient subsequently recovered. Additional information has been requested.


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