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This is VAERS ID 276801

Case Details

VAERS ID: 276801 (history)  
Form: Version 1.0  
Age: 21.0  
Gender: Female  
Location: Unknown  
Vaccinated:2006-12-01
Onset:2006-12-01
   Days after vaccination:0
Submitted: 2007-04-13
   Days after onset:132
Entered: 2007-04-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK - / -

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: None
Current Illness: Sulfonamide allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES0703USA03402

Write-up: Information has been received from the mother of a 21 year old female with sulfonamide allergy who in December 2006, was vaccinated with 0.5 ml Gardasil IM and fainted afterward. There was no concomitant medication. Subsequently, the patient recovered. Unspecified lab testing was performed. Additional information is not expected.


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