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This is VAERS ID 279487

Case Details

VAERS ID: 279487 (history)  
Form: Version 1.0  
Age: 18.0  
Gender: Female  
Location: Virginia  
Vaccinated:2007-04-17
Onset:2007-04-17
   Days after vaccination:0
Submitted: 2007-05-14
   Days after onset:27
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / 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: ZYRTEC
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0704USA03925

Write-up: This is in follow-up to report(s) previously submitted on 5/14/2007. Initial and follow-up information has been received from a Licensed Practical Nurse (L.P.N.) concerning an 18 year old female student with no pertinent medical history or drug reactions/allergies who on 17-APR-2007 at approximately 3:55 PM was vaccinated IM in left deltoid with a first dose of Gardasil (lot # 0378U not valid). Concomitant therapy included ZYRTEC. On 17-APR-2007 at approximately 4:00 the patient fainted in her chair soon after the administration of her first injection. She recovered quickly after she was placed on the floor and her legs were elevated. This is one of three reports from the same source. Additional information has been requested.


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