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This is VAERS ID 276228

Case Details

VAERS ID: 276228 (history)  
Form: Version 1.0  
Age: 17.0  
Gender: Female  
Location: Florida  
Vaccinated:2007-03-07
Onset:2007-03-07
   Days after vaccination:0
Submitted: 2007-04-06
   Days after onset:29
Entered: 2007-04-09
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0800F / 2 LA / IM

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
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: hormonal contraceptives
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0703USA01294

Write-up: Information has been received from a Registered Nurse (R.N.) concerning a 17 year old female patient who on 10-JAN-2007 was vaccinated with her first dose of Gardasil. On 03-MAR-2007 she was vaccinated IM in her left deltoid with her second dose of Gardasil, lot #654540/0800F. Concomitant therapy included oral contraceptives (unspecified). Shortly after the administration of her second dose,


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