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This is VAERS ID 283534

Case Details

VAERS ID: 283534 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: Arizona  
Vaccinated:2007-06-26
Onset:2007-06-26
   Days after vaccination:0
Submitted: 2007-06-26
   Days after onset:0
Entered: 2007-07-02
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0960F / 3 RA / -

Administered by: Private       Purchased by: Public
Symptoms: Feeling abnormal, Mydriasis, Pallor, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (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:
Current Illness: none
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: After receiving Gardasil at about 920am the pt stated R arm felt weird then turned pale, eyes dilated and fainted. Dr was called into the room immediately and examined pt and observed her for 45-50 min, then pt acted normal and went home.


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