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This is VAERS ID 272297

Case Details

VAERS ID: 272297 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: Kentucky  
Vaccinated:2006-10-13
Onset:2006-10-13
   Days after vaccination:0
Submitted: 2007-02-14
   Days after onset:124
Entered: 2007-02-15
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: Drug hypersensitivity
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES0701USA00800

Write-up: Information has been received from a physician concerning a 15 year old female patient who was vaccinated with a first and second dose of Gardasil (yeast). Subsequently the patient fainted 15 minutes after each vaccination. Unspecified medical attention was sought. Additional information has been requested. 07/06/07 This is in follow-up to report(s) previously submitted on 2/14/2007. Initial and follow up information has been received from a physician and a nurse practitioner concerning a 16 year old female with drug hypersensitivity to CECLOR who on 13-OCT-2006, at 15:00 was vaccinated, IM into the left arm with a first dose of GARDASIL (lot# 653978/0955F). The patient fainted 15 minutes after vaccination. On 13-Oct-2006, the patient recovered on her own with mild dizziness, oriented times 3. On 13-DEC-2006, at 15:30 the patient was vaccinated, IM into the right arm with a second dose of GARDASIL (lot# 654389/0961F). She again fainted 10 minutes after vaccination. On 13-DEC-2006, the patient recovered on her own, oriented time 3. There were no laboratory or diagnostic test performed. No further information is available.


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