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This is VAERS ID 283757

Case Details

VAERS ID: 283757 (history)  
Form: Version 1.0  
Age: 17.0  
Gender: Female  
Location: Unknown  
   Days after vaccination:0
Submitted: 2007-06-14
   Days after onset:58
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Dizziness, Injection site pain
SMQs:, Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (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: [therapy unspecified]; MENACTRA
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC Split Type: WAES0705USA00858

Write-up: Information has been received from a physician via a company representative concerning a 17 year old female patient with an unremarkable medical history and no known drug reactions/allergies who on 17-APR-2007 was vaccinated with Gardasil (Lot #654510/0962F). Concomitant therapy included Menactra and "T-DEP vaccines". On 17-APR-2007 the patient experienced pain at injection site and felt faint right after receiving this initial dose. The patient felt fine upon observation by the health care provider about 20 minutes after receiving the injection. It was noted the patient received her vaccine injection on an empty stomach. Subsequently, the patient recovered from pain at injection site and felt faint right after receiving initial dose. It was also noted the patient will receive future doses of Gardasil. No further information is available.

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