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This is VAERS ID 281958

Case Details

VAERS ID: 281958 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: Texas  
Vaccinated:2007-06-15
Onset:2007-06-15
   Days after vaccination:0
Submitted: 2007-06-15
   Days after onset:0
Entered: 2007-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 1 LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Fall, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient Recieved HPV vaccine in LA. Walked out of the clinic and building, tripped and fainted. Mom sent younger sister in to get me. We got a wheel chair and brought her back into the clinic, on the way in she fainted again. Got her on to the bed and took BP 106/57. After 5 min sat her up and retook BP 105/54. Got her to the wheel chair and gave her a drink of water and took her to the ER. Gave report to the ER nurse.


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