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This is VAERS ID 276244

Case Details

VAERS ID: 276244 (history)  
Form: Version 1.0  
Age:   
Gender: Unknown  
Location: Unknown  
Vaccinated:2007-02-07
Onset:2007-02-07
   Days after vaccination:0
Submitted: 2007-04-06
   Days after onset:57
Entered: 2007-04-09
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0012U / 2 - / -

Administered by: Unknown       Purchased by: Unknown
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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: YASMIN, PROTONIX, PAXIL
Current Illness: Contraception
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0703USA04318

Write-up: Information has been received from a certified medical assistant concerning a patient with contraception who on 07-FEB-2007 was vaccinated with second dose of Gardasil (Lot#655503/0012U). Concomitant therapy included YASMIN, PAXIL and PROTONIX. On 07-FEB-2007, the patient experienced fainted (patient outcome not provided). Additional information has been requested. The same source also provided information regarding other patients'' experiences (WAES#0703USA01200 and WAES#0703USA04319).


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