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This is VAERS ID 276946

Case Details

VAERS ID: 276946 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: California  
Vaccinated:2007-03-23
Onset:2007-03-23
   Days after vaccination:0
Submitted: 2007-04-13
   Days after onset:21
Entered: 2007-04-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ZYRTEC
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0704USA00199

Write-up: Information has been received from a physician concerning a 14 year old female who on approximately 23-MAR-2007, was vaccinated intramuscularly with a first dose of Gardasil vaccine (yeast). On approximately 23-MAR-2007 the patient fainted. The patient did not seek medical attention. Subsequently, the patient recovered. Additional information has been requested. This is in follow-up to report (s) previously submitted on 4/11/2007. Initial and follow-up information has been received from a physician concerning a 14 year old female who on 12-MAR-2007, at 16:30 was vaccinated intramuscular with a first dose of GARDASIL (lot #654510/0962F). Concomitant therapy included ZYRTEC. On 12-MAR-2007 the patient experienced syncope following vaccination. The patient was given water and trail mix. Te patient also experienced loss of consciousness for a few second. She fell inito a chair in the waiting room and developed a bruise on her left stapula. The patient was observed for 20 minutes. On 12-MAR-2007 the patient recovered. Additional information is not expected.


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