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This is VAERS ID 276144

Case Details

VAERS ID: 276144 (history)  
Age: 19.0  
Gender: Female  
Location: Unknown  
Vaccinated:2007-03-05
Onset:2007-03-05
   Days after vaccination:0
Submitted: 2007-04-06
   Days after onset:31
Entered: 2007-04-09
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 653937/0637F / 1 - / IN

Administered by: Other       Purchased by: Other
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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data:
CDC Split Type: WAES0703USA00698

Write-up: Information has been received from a pharmacist concerning a 19 year old female with pertinent medical history and drug reactions/allergies reported as none who on 05, Mar 2007 was vaccinated with the second dose of HPV rL1 6 11 16 18 VLP vaccine (yeast), ( lot # 653937/0637F). Concomitant medication was reported as none. On 05, Mar 2007, 5 to 10 minutes after receiving the vaccination, the patient fainted. The patient sought unspecified medical attention. The outcome and causality of the event was not reported. Additional information has been requested.


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