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This is VAERS ID 276670

Case Details

VAERS ID: 276670 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: Texas  
   Days after vaccination:0
Submitted: 2007-04-13
   Days after onset:41
Entered: 2007-04-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Private
Symptoms: Fall, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), 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
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0703USA02372

Write-up: Information has been received from a nurse concerning a 16 year old female (ptreviously reported as 15 year old) with no illness at the time of vaccination and no pre-existing illness or allergies who on 02-MAR-2007 (previously reported as 09-MAR-2007) was vaccinated with first dose of Gardasil (lot# 657006/0188U). 0.5 ml once IM in the left deltoid at 5:15 PM. On 02-MAR-2007, after receiving the injection, the patient fainted and fell from the chair where she was sitting. Medical attention was sought. However, she regained consciousness after five minutes. She went home after the recovery. No further information was available at the time of reporting. Additional information has been requested. Additional infromation was received from a licensed vocational nurse. On 02-MAR-2007, at 5:15 PM after receiving the vaccination the patient stated that she felt lightheaded and fell forward and laid her head on the nurses shoulder. The patient then briefly had a "seizure like" motion of her head. The nurse laid her back on the table. The patient quickly resumed normal fucntion and stated she felt fine. The physician stated vasovagal episode. No additional information is expected.

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