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This is VAERS ID 283760

Case Details

VAERS ID: 283760 (history)  
Form: Version 1.0  
Age: 17.0  
Gender: Female  
Location: Tennessee  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2007-06-14
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Arrhythmia
SMQs:, Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES0705USA00926

Write-up: Information has been received from a physician concerning a 17 year old female who was vaccinated with Gardasil. Subsequently the patient experienced arrhythmia after receiving a dose of Gardasil. It was not known which dose this was in the series. Outcome was unknown. Additional information has been requested.


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