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This is VAERS ID 279179

Case Details

VAERS ID: 279179 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: Unknown  
Vaccinated:2007-03-26
Onset:2007-03-26
   Days after vaccination:0
Submitted: 2007-05-14
   Days after onset:49
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Dizziness, Injection site pain, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0704USA01490

Write-up: Information has been received from a Registered Nurse (R.N.) concerning an 11 year old female patient who on 26-MAR-2007 was vaccinated with the first dose of 0.5 mL of Gardasil. The "patients became light headed and fainted after receiving the dose of Gardasil." The nurse reported that the patient had "experienced 2 weeks of injection site soreness." Unspecified medical attention was sought by the patient. Injection site soreness persisted. Additional information has been requested.


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