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This is VAERS ID 276143

Case Details

VAERS ID: 276143 (history)  
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 / 0 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
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
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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