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This is VAERS ID 274744

Case Details

VAERS ID: 274744 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: California  
Vaccinated:2007-02-12
Onset:2007-02-12
   Days after vaccination:0
Submitted: 2007-03-14
   Days after onset:29
Entered: 2007-03-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Computerised tomogram, Head injury, Headache, 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? No
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: Unknown
CDC Split Type: WAES0703USA00940

Write-up: Information has been received from a physician concerning a female who on approximately 12-FEB-2007 was vaccinated intramuscularly with a dose of Gardasil. On approximately 12-FEB-2007 the patient fainted after the administration of Gardasil. It was reported that this patient may have fainted while on the way to the car and hit her head at an unspecified area. Medical attention was sought and the patient''s mother was requesting a computed axial tomography because the patient was experiencing bad headaches. At the time of the report, the patient''s outcome was unknown. Additional information has been requested.


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