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This is VAERS ID 279667

Case Details

VAERS ID: 279667 (history)  
Age: 14.0  
Gender: Female  
Location: Missouri  
Vaccinated:2007-04-11
Onset:2007-04-11
   Days after vaccination:0
Submitted: 2007-05-14
   Days after onset:33
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - 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
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0705USA00170

Write-up: Information has been received from a physician concerning a 14 female who on 11-APR-2007 was vaccinated with a 0.5 mL dose of Gardasil (Lot # "03874"). Subsequently, the patient fainted 5 minutes after receiving the Gardasil. At the time of this report, the patient had recovered. No product quality complaint was involved. Additional information has been requested.


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