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This is VAERS ID 276143

Case Details

VAERS ID: 276143 (history)  
Form: Version 1.0  
Age: 18.0  
Gender: Female  
Location: New Jersey  
Vaccinated:2007-02-28
Onset:2007-02-28
   Days after vaccination:0
Submitted: 2007-04-06
   Days after onset:36
Entered: 2007-04-09
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / 1 UN / IM

Administered by: Private       Purchased by: Private
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), 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? 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: WAES0703USA00680

Write-up: Information has been received from a registered nurse concerning a 16 year old female with no previous drug reactions who on 26, Feb 2007, was vaccinated with HPV rL1 6 11 16 18 VLP vaccine (yeast) first dose. On 26, Feb 2007, the patient fainted after receiving HPV rL1 6 11 16 18 VLP vaccine (yeast). Unspecified medical attention was sought. The patient recovered from fainting the same day the vaccine was received. Additional information has been requested. This is in follow-up to report (s) previously submittedo n 4/6/2007. Initial follow up information has been received. Follow up information indicated that on 28-Feb-2007, the patient fainted (previously mentioned as on 26-Feb-2007) after receiving the first injection. Unspecified medical attention was sought. On 28-Feb-2007 patient recovered. Additional information is not expected.


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