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This is VAERS ID 272306

Case Details

VAERS ID: 272306 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: New York  
Vaccinated:2006-12-22
Onset:2006-12-22
   Days after vaccination:0
Submitted: 2007-02-14
   Days after onset:54
Entered: 2007-02-15
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1424F / UNK UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Feeling abnormal, Malaise, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: Ortho Tri Cyclen
Current Illness: Penicillin allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: WAES0701USA01016

Write-up: Information has been received from a physician concerning a 19 year old female with a penicillin allergy and no other pertinent medical history reported. On 22-DEC-2006, the patient was vaccinated intramuscularly with one dose of Gardasil (Lot #654885/1424F). Concomitant therapy included Ortho Tri Cyclen. On 22-DEC-2006, the patient felt nauseous shortly after administration. The patient then fainted for approximately 10 seconds while she was at the office. The patient remained in the office until she felt "normal" again. The patient then went home where later she felt sick again. The patient went to the emergency room and was then released. It was reported that there were no laboratory diagnostics performed at the physician''s office and it was unknown it any were performed in the emergency room. At the time of this report, the patient had recovered from the events (date unknown). Additional information has been requested.


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