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This is VAERS ID 274301

Case Details

VAERS ID: 274301 (history)  
Form: Version 1.0  
Age: 20.0  
Gender: Female  
Location: Michigan  
Vaccinated:2007-02-19
Onset:2007-02-19
   Days after vaccination:0
Submitted: 2007-03-14
   Days after onset:22
Entered: 2007-03-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0013U / 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? Yes
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: WAES0702USA03530

Write-up: Information has been received from a nurse concerning a 20 year old female who on 19-FEB-2007 was vaccinated IM with a dose of Gardasil (Lot # 654741/0013U). On 19-FEB-2007, the patient fainted after receiving the Gardasil injection. The patient was known by the provider to be squeamish with injections. After the fainting episode, the patient was observed for a brief period of the time and then was discharged from the physician''s office. On 19-FEB-2007, the patient recovered. No product quality complaint was involved. Additional information has been requested.


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