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This is VAERS ID 277187

Case Details

VAERS ID: 277187 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: Texas  
   Days after vaccination:0
Submitted: 2007-04-04
   Days after onset:7
Entered: 2007-04-23
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1424F / 1 - / IM

Administered by: Private       Purchased by: Public
Symptoms: Deafness, Fall, Head injury, Syncope, Visual disturbance
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), 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: NONE
Current Illness: Ingrown toenail
Preexisting Conditions: NKDA
Diagnostic Lab Data:
CDC Split Type: TX07026

Write-up: Patient was administered the HPV (Gardasil) #1 vaccine at 12:30 pm. Patient was sitting when the vaccine was administered, she got up from the exam table, standing besides the table. Patient fainted, falling on the floor, hitting her head to left side, pt. said she stopped hearing and saw everything white. She was helped from the floor and placed on exam table on a laying position. She was resting for 1 hour. Pt after 1 hour felt better and left the office walking.

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