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This is VAERS ID 279670

Case Details

VAERS ID: 279670 (history)  
Form: Version 1.0  
Age: 17.0  
Gender: Female  
Location: Texas  
Vaccinated:2007-01-04
Onset:0000-00-00
Submitted: 2007-05-14
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1425F / 1 UN / IM

Administered by: Private       Purchased by: Private
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? No
Office Visit? No
ER Visit? No
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: WAES0705USA00372

Write-up: Information has been received from a physician, via a company representative, concerning a 17 year old female patient who was vaccinated IM (date unspecified), with the first dose of Gardasil. The physician reported that the patient "fainted in the office waiting room shortly after being vaccinated." The physician stated the patient was presumed to be doing fine, though she had not heard from the patient. The patient sought unspecified medical attention. Additional information has been requested. This is in follow-up to report(s) previously submitted on 5/14/2007. Initial and follow up information has been received froma physician, concerning a 17 year old female patient, with no known drug allergies, who on 04-JAN-2007, was vaccinated IM in the lteft arm, with the first dose of GARDASIL (Lot #655165/1425F). Follow up information added that the patient had developed an area of induration at the site of injection (date of onset not specified). The physician indicated that the patient did not require an office visit or other treatment. At the time of this report, the outcome of both events was unknown. Additional information has neem requested.


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