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This is VAERS ID 274700

Case Details

VAERS ID: 274700 (history)  
Age: 18.0  
Gender: Female  
Location: Florida  
Vaccinated:2006-12-14
Onset:2006-12-27
   Days after vaccination:13
Submitted: 2007-03-14
   Days after onset:76
Entered: 2007-03-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - - / IM

Administered by: Other       Purchased by: Other
Symptoms: Pain in extremity, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: (therapy unspecified)
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0702USA04301

Write-up: Information has been received from a mother concerning her 18 year old daughter who on 14-DEC-2006 was vaccinated with Gardasil (lot # not reported) IM. Concomitant therapy included "TENUS therapy unspecified and hepatitis A virus vaccine (unspecified)" date not provided. The mother reported that her daughter fainted and also experienced pain in her arm after receiving Gardasil. The onset date was reported as 24-Dec-2006. At the time of reporting, the patient had recovered. Additional information has been requested. Information has been received from a mother concerning her 18 year old daughter who on 14-DEC-2006 was vaccinated with a first dose of GARDASIL (lot # 654389/0961F) IM in the left arm. Concomitant therapy also given on 14-DEC-2006 included a first dose of HEPATITIS A virus vaccine inactivated (Lot # 656495/1209P) in the left arm and a first dose of ADADEL (lot # 538AA) given in the right arm. The mother reported that her daughter fainted and also experienced pain in her arm after receiving GARDASIL. The onset date was reported as 27-DEC-2006.At the time of reporting, the patient hasd recovered. Additional information was received from the phyhsician. The patient fainted on 14-DEC-2006 and subsequently recovered. On 12-MAR-2007, the patient was vaccinated withthe second dose of GARDASIL (lot # 654389/0961P) in the right arm. No reports of fainting, no problem. No additional information is expected.


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