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This is VAERS ID 274590

Case Details

VAERS ID: 274590 (history)  
Form: Version 1.0  
Age: 22.0  
Gender: Female  
Location: Michigan  
Vaccinated:2007-01-03
Onset:2007-01-03
   Days after vaccination:0
Submitted: 2007-03-14
   Days after onset:69
Entered: 2007-03-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 1 RA / 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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES0702USA04082

Write-up: Information has been received from a physician concerning her daughter who was vaccinated with a dose of HPV during her Christmas holiday break from college. After the vaccination, the patient walked to the reception desk and fainted. The patient awoke by herself. Unspecified medical attention was sought. It was reported that the patient was embarrassed, then walked out to the car with her parents. Subsequently, the patient recovered. Additional information has been requested. This is in follow-up to report (s) previously submitted on 3/14/2007. Initial and follow-up information has been received from two physicians concerning their daughter, a 22 year old female with ulcerative colitis (in remission) who on 03-JAN-2007, at 3:00 pm, was vaccinated intramuscularly into the right deltoid with the first dose of GARDASIL (Lot # 659978/0955F), during her holiday break from college. The physician reported that on 03-JAN-2007, at 3:15 pm, the patient experienced vaso-vagal faint. The patient awoke by herself. Unspecified medical attention was sought. Subsequently, the patient recovered from vaso-vagal faint. It was reported that the patient was embarrassed, then walked out to the care with her parents. Additional information is not expected.


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