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This is VAERS ID 279235

Case Details

VAERS ID: 279235 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: New York  
Vaccinated:2007-04-01
Onset:2007-04-01
   Days after vaccination:0
Submitted: 2007-05-14
   Days after onset:43
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Dizziness, 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), Vestibular disorders (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? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ALEVE
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0704USA03464

Write-up: Information has been received from a nurse practitioner, via a company representative, concerning a 16 year old female patient, who in April 2007, was vaccinated with a dose of Gardasil. Concomitant therapy included Menactra and Vaqta. The nurse practitioner stated that the patient "fainted after she received the Gardasil vaccination. " The "patient was given liquids to drink and something to eat, and she was fine." Additional information has been requested. This is in follow-up to report (s) previously submitted on 5/14/2007. Initial follow up information has been received. There was no illness at the time of vaccination. The nurse practioner stated that as the patient walked from the exam room at 8:35, she felt lightheaded, passed out and fell and hit her right occipital area. The NP stated that the patient had not eaten that morning, and was given juice and a banana. The patient left the office after about 10 minutes, and recovered on the same day, 10-Mar-2007. No further information is expected.


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