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This is VAERS ID 271697

Case Details

VAERS ID: 271697 (history)  
Form: Version 1.0  
Age: 18.0  
Gender: Female  
Location: Michigan  
Vaccinated:2007-01-17
Onset:2007-01-17
   Days after vaccination:0
Submitted: 2007-01-29
   Days after onset:12
Entered: 2007-02-05
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1162F / 1 GM / -

Administered by: Private       Purchased by: Public
Symptoms: Electrocardiogram, Syncope vasovagal
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EKG-ne
CDC Split Type:

Write-up: Patient suffered a vasovagal (syncope) reaction after vaccine given. Sent to ER


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