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This is VAERS ID 276804

Case Details

VAERS ID: 276804 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: New York  
Vaccinated:2007-03-09
Onset:2007-03-09
   Days after vaccination:0
Submitted: 2007-04-13
   Days after onset:34
Entered: 2007-04-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Pallor
SMQs:, Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES0703USA03455

Write-up: Information has been received from a physician concerning a 16 year old female with no reported medical history who on 09-MAR-2007 was vaccinated with Gardasil intramuscularly. There was no concomitant medication. On 09-MAR-2007 the patient experienced a pale face. Subsequently, the patient recovered from pale face. Additional information has been requested.


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