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This is VAERS ID 275509

Case Details

VAERS ID:275509 (history)  Vaccinated:0000-00-00
Age:13.0  Onset:0000-00-00
Gender:Female  Submitted:2007-04-02
Location:Unknown  Entered:2007-04-03, Days after submission: 1
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: electrocardiogram - prolonged Q-T, total heartbeat count over
CDC 'Split Type': WAES0703USA04642
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC. 0IM 
Administered by: Public     Purchased by: Other
Symptoms: Electrocardiogram QT prolonged, Heart rate increased, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Torsade de pointes, shock-associated conditions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Information has been received from a nurse practitioner concerning a 13 year old female who on an unspecified date was vaccinated with first dose, single dose vial, of Gardasil (lot # not reported) IM injection. On an unspecified date, within 10 minutes of receiving the vaccination, the patient passed out. The patient''s heart rate was over 200. The patient passed out a total of three times. Medical attention was sought. The patient was hospitalized as a result of the experience. At the time of reporting, the patient had prolonged Q-T and was being seen by a cardiologist for the condition. The outcome of the events was unknown. The reporter considered the events to be immediately life-threatening. Additional information has been requested.

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