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This is VAERS ID 283534

Case Details

VAERS ID: 283534 (history)  
Age: 11.0  
Gender: Female  
Location: Arizona  
   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 / 2 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
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions:
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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