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This is VAERS ID 276869

Case Details

VAERS ID: 276869 (history)  
Age: 19.0  
Gender: Female  
Location: Ohio  
Vaccinated:2007-03-20
Onset:2007-03-20
   Days after vaccination:0
Submitted: 2007-04-13
   Days after onset:24
Entered: 2007-04-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0244U / 0 - / IM

Administered by: Private       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
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: LOESTRIN
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0703USA04224

Write-up: Information has been received from a registered nurse concerning a 19 year old female who on 20 Mar-2007 was vaccinated with a 0.5 ml dose of Gardasil vaccine (yeast) (lot # 656051/0244U). Concomitant medication included ethinyl estradiol (+) norethindrone acetate "1/20 BCP''s." On 20-MAR-2007 the patient fainted after receiving a shot of the vaccine. The patient laid down, smelling salt used and was given juice and a granola bar. The patient had not eaten since the night before. Subsequently, the patient recovered in less than 5 minutes. No product quality complaint was involved. Additional information has been requested.


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