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This is VAERS ID 274714

Case Details

VAERS ID: 274714 (history)  
Form: Version 1.0  
Gender: Female  
Location: Unknown  
   Days after vaccination:0
Submitted: 2007-03-14
   Days after onset:71
Entered: 2007-03-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Face injury, Haemorrhage, Syncope, X-ray
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Post procedural nausea
Diagnostic Lab Data: x-ray, 01/01/07, nose not broken
CDC Split Type: WAES0702USA04505

Write-up: Information has been received from a nurse practitioner concerning a female (age not reported) with a history of "becomes sqeemish after being administered shots" who on approximately 01-JAN-2007 (about 8 weeks ago) was vaccinated with the first dose of HPV. Concomitant medication was not reported. On approximately 01-JAN-2007 (about 8 weeks ago), the patient fainted in the elevator after being administered the HPV and she hit her nose which started to bleed. The patient sought unspecified medical attention and was given an x-ray which showed that her nose was not broken. The patient was recovering from the events. Additional information has been requested.

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