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This is VAERS ID 274120

Case Details

VAERS ID: 274120 (history)  
Form: Version 1.0  
Age: 24.0  
Gender: Female  
Location: Illinois  
Vaccinated:2006-11-21
Onset:2006-11-21
   Days after vaccination:0
Submitted: 2007-03-14
   Days after onset:112
Entered: 2007-03-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0954F / 1 UN / IM

Administered by: Private       Purchased by: Other
Symptoms: Fatigue, Influenza, Insomnia
SMQs:, Infective pneumonia (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: Inderal
Current Illness: Syncope
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0702USA00593

Write-up: This is in follow-up to report(s) previously submitted on 3/14/2007. Information has been received from a Certified Medical Assistant concerning a 24 year old female patient with neurocardiogenic syncope who on 21-NOV-2006 was vaccinated IM with her first dose of Gardasil, lot #653938/0954F. Concomitant therapy included INDERAL. On 21-NOV-2006 the patient experienced insomnia for one month following the administration of Gardasil. She later had the flu from being run down and lack of sleep. The patient desired a prescription for sleep after her next injection. Unspecified medical attention was sought. The patient was reported as recovered. Additional information is not expected.


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