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This is VAERS ID 282242

Case Details

VAERS ID: 282242 (history)  
Form: Version 1.0  
Age: 17.0  
Gender: Female  
Location: California  
Vaccinated:2007-06-05
Onset:2007-06-05
   Days after vaccination:0
Submitted: 2007-06-12
   Days after onset:7
Entered: 2007-06-19
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB162CB / 1 RA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0181U / 1 LA / -

Administered by: Private       Purchased by: Public
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: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient fainted after 2-3 min. Vitals were normal. After observation for 15 min patient was able to walk on own and left office in care of her mom. No seizure activity. LOC was brief perhaps <10 secs. Exam on departure were normal


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