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This is VAERS ID 282966

Case Details

VAERS ID: 282966 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: California  
Vaccinated:2007-06-19
Onset:2007-06-19
   Days after vaccination:0
Submitted: 2007-06-19
   Days after onset:0
Entered: 2007-06-27
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0523U / 1 LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Feeling abnormal, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (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: Multivitamin
Current Illness:
Preexisting Conditions: Dizziness & lightheadedness
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received vaccine and then sat for about 7-8 minutes. Upon checking out pt stated that she didn''t feel right and fainted. Pt came around a minute later sat for awhile and was released


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