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This is VAERS ID 279559

Case Details

VAERS ID: 279559 (history)  
Form: Version 1.0  
Age: 24.0  
Gender: Female  
Location: Unknown  
Vaccinated:2007-04-23
Onset:2007-04-23
   Days after vaccination:0
Submitted: 2007-05-14
   Days after onset:21
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0384U / 2 UN / UN

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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES0704USA05279

Write-up: Information has been received from a physician concerning a 24 year old female who on 23-APR-2007 was vaccinated with Gardasil (Lot# 657617/0384U). On 23-APR-2007 the patient fainted before receiving dose two. The patient recovered and received the second dose that same day. Additional information is not expected.


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