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This is VAERS ID 279992

Case Details

VAERS ID: 279992 (history)  
Form: Version 1.0  
Age: 17.0  
Gender: Female  
Location: Washington  
Vaccinated:2007-05-22
Onset:2007-05-22
   Days after vaccination:0
Submitted: 2007-07-06
   Days after onset:45
Entered: 2007-05-30
   Days after submission:37
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 655620/0171U / 1 LA / -

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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Concurrent Conditions: Anxiety, Panic Attack
Preexisting Conditions: Anxiety/Panic attacks
Allergies:
Diagnostic Lab Data: blood pressure, 05/22/07, 115/6;pulse oximetry, 05/22/07, 97 percent; total heartbeat count, 05/22/07, 68
CDC Split Type:

Write-up: Fainting episode within 5 minutes of Gardasil injection. This is in follow-up to report(s) previously submitted on 6/14/2007. Initial and follow-up information has been received from a physician concerning a 17 year old female with anxiety and panic attack who on 22-MAY-2007, at 16:30 was vaccinated, into the left deltoid , with a first dose of GARDASIL vaccine (yeast) (lot #. On 22-MAY-2007, at 16:33, the patient experienced fainting. Blood pressure was 115/60, heart rate was 68 and oxygen saturation was 97 percent. On 22-MAY-2007, within a few minutes , the patient recovered without medical intervention.. No further infoarmation is available


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