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This is VAERS ID 276065

Case Details

VAERS ID: 276065 (history)  
Age: 16.0  
Gender: Female  
Location: Rhode Island  
Vaccinated:2007-03-22
Onset:2007-03-22
   Days after vaccination:0
Submitted: 2007-04-11
   Days after onset:20
Entered: 2007-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / 0 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1300F / 1 - / SC

Administered by: Private       Purchased by: Public
Symptoms: Blood pressure normal, Fall, Heart rate normal, 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
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Syncopal episode appr 5-7 mins after administration of IM Gardasil. Fell at our check out window with no alerts anyone- BP 116/80 BP normal/prior to exam 120/80 P. 92


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