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This is VAERS ID 283777

Case Details

VAERS ID: 283777 (history)  
Age: 18.0  
Gender: Female  
Location: New York  
Vaccinated:2007-03-20
Onset:2007-03-20
   Days after vaccination:0
Submitted: 2007-06-14
   Days after onset:86
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. - / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0185U / 0 UN / IM

Administered by: Private       Purchased by: Private
Symptoms: Dizziness, Immediate post-injection reaction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0705USA01309

Write-up: Initial information has been received from a physician and follow up information has been received from a nurse concerning a female patient between the ages of 11 and 19 who was vaccinated with a first dose of Gardasil. It was reported that the patient sat for a minute (after receiving the injection) and when she got up to leave she fainted in the hallway. Her outcome was not reported. The physician reported that lot numbers were not available, however, the physician will forward other information including the lot numbers. Additional information has been requested. This is in follow-up to report (s) previously submitted on 6/14/2007. Follow-up information has been received from a health professional concerning the 19 year old female student with no medical history who on 20Mar-2007 at 3:15 p.m. was vaccinated IM with her first dose of GARDASIL, lot # 655618/0186U. Concomitant medication included a second dose of VAQTA (manufacturer not reported). At 3:15 p.m. the patient experienced dizziness (also reported as within 5 minutes of administration the patient experineced dizziness). The dizziness lasted approximately 5 minutes. The patient laid down on teh exam table and walked out on her own after 10 minutes. Additional infomation is not expected.


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