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This is VAERS ID 276065

Case Details

VAERS ID: 276065 (history)  
Form: Version 1.0  
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 / 1 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1300F / 2 - / 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
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
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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