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This is VAERS ID 276948

Case Details

VAERS ID: 276948 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: California  
Submitted: 2007-04-13
Entered: 2007-04-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 - / 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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: unknown
CDC Split Type: WAES0704USA322

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

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