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This is VAERS ID 272321

Case Details

VAERS ID: 272321 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: New York  
Vaccinated:2007-01-08
Onset:2007-01-08
   Days after vaccination:0
Submitted: 2007-02-14
   Days after onset:37
Entered: 2007-02-15
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK - / IM

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? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0701USA01532

Write-up: Information has been received from a physician concerning a female who on 08-JAN-2007 was vaccinated IM with a dose of Gardasil (yeast). It was noted that the patient fainted during the administration of the vaccine, the patient outcome was unknown. No product quality complaint was involved. Additional information has been requested.


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