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This is VAERS ID 276957

Case Details

VAERS ID: 276957 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Unknown  
   Days after vaccination:0
Submitted: 2007-04-13
   Days after onset:172
Entered: 2007-04-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / 2 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Loss of consciousness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Allergic reaction to antibiotics
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0704USA00713

Write-up: Information has been received from a registered nurse concerning a "late teens" female who, "about 4 months ago," in approximately December 2006, was vaccinated with her first dose of Gardasil (dose and date not reported). Subsequently the patient fainted about six hours after receiving her first dose. Patient reported experience when in office for second dose. Additional information has been requested. 07/06/07 This is in follow-up to report(s) previously submitted on 4/13/2007. Information has been received from a licensed practical nurse concerning a 15 year old female with an allergy to KEFLEX who on 27-JUL-2006 and 23-OCT-2006 was vaccinated IM with her first and second 0.5 ml dose of GARDASIL (lot# 653937/0637F). It was reported that the patient came in for her third dose and she told the nurse that she had passed out a couple hours after her second vaccination (recovered same day 23-OCT-2006). She was advised per her physician''s office that she could not be administered the vaccine without a parent available to drive her home. The patient came back in with her mother. The patient''s mother was advised that this reaction could be worse than the second reaction and could possible require medical attention. The patient was vaccinated IM with her third 0.5 ml dose on 14-FEB-2007. The patient''s mother agreed to monitor her that evening. Additional information is not expected.

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