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This is VAERS ID 276947

Case Details

VAERS ID: 276947 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: California  
Vaccinated:2007-03-01
Onset:2007-03-01
   Days after vaccination:0
Submitted: 2007-04-13
   Days after onset:42
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: Unk
Current Illness:
Preexisting Conditions: Unk
Allergies:
Diagnostic Lab Data: Unk
CDC Split Type: WAES0704USA00321

Write-up: Information has been received from a physician concerning a 15 year old female who in approximately March 2007 was vaccinated, intramuscularly, into the deltoid, with a first dose of Gardasil concomitantly with a dose of Menactra. In approximately March 2007 the patient fainted. Subsequently, the patient recovered. Additional information has been requested.


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