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This is VAERS ID 282964

Case Details

VAERS ID: 282964 (history)  
Age: 18.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2007-06-18
Onset:2007-06-18
   Days after vaccination:0
Submitted: 2007-06-19
   Days after onset:1
Entered: 2007-06-27
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 05220 / 0 LA / IM
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR C2720AA / 0 LA / 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
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: on Ortho-tri-cyclen 1 tab PO QD
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Syncopal episode approx 5 min after administration


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