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This is VAERS ID 274597

Case Details

VAERS ID: 274597 (history)  
Form: Version 1.0  
Age: 25.0  
Gender: Female  
Location: New York  
   Days after vaccination:0
Submitted: 2007-03-14
   Days after onset:21
Entered: 2007-03-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Private
Symptoms: Head injury, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), 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: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0702USA04224

Write-up: This is in follow-up to report(s) previously submitted on 3/14/2007. Initial and follow up information has been received from two registered nurses concerning a 25 year old previously reported as 24 year old) female teacher, who at 11:40, on 20-FEB-2007 was vaccinated with the first dose of, 0.5 ml dose, IM, of GARDASIL. There was no concomitant medication. The nurse reported that at 11:50am, ten minutes after the vaccine was administered. The teacher fainted, experienced a loss of consciousness (previously reported as "did not lose consciousness") and "fell to the ground" but was easily awakened. The nurse reported that the teacher hit the back of her head when she fell and complained of a headache/pain. The physician evaluated the teacher and offered to call an ambulance, but the teacher "refused" further care. The nurse stated that the teacher was walked her to the car at 12:30pm by her mother, and the patient was "awake, alert and oriented" The nurse confirmed that the patient recovered on 21-FEB-2007. No further information is available

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