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This is VAERS ID 274316

(NOTE: This result is from the 12/8/2009 version of the VAERS database)

Case Details

VAERS ID: 274316 (history)  
Form: Version .0  
Age: 15.0  
Gender: Female  
Location: Maryland  
Vaccinated:2007-02-01
Onset:2007-02-01
   Days after vaccination:0
Submitted: 2007-03-14
   Days after onset:40
Entered: 2007-03-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / -
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -

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)

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: WAES0702USA03735

Write-up: Information has been received from a physician, via a company representative, concerning a 15 year old female patient who was vaccinated "during the last couple of weeks" (February 2007), with the first dose of Gardasil. Concomitant suspect therapy included other vaccines (therapy unspecified) that were administered at the visit. The physician reported that the patient "fainted after getting Gardasil and several other vaccines were administered at the same visit. Subsequently, the patient recovered. The patient sought unspecified medical attentions. Additional information has been requested.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20091208&IDNUMBER=274316


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