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This is VAERS ID 284163

Case Details

VAERS ID: 284163 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2007-05-19
Onset:2007-05-19
   Days after vaccination:0
Submitted: 2007-06-14
   Days after onset:26
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Blood pressure, Heart rate, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: blood pressure, 05/19/07, 110/70; total heartbeat count, 05/19/07, 72
CDC Split Type: WAES0705USA03876

Write-up: Information has been received from a physician concerning a 14 year old female who on 19-MAY-2007 was vaccinated with the 1st dose Gardasil. There was no concomitant medication nor pertinent medical history. Subsequently the patient experienced syncopal episode within 5 minutes. Blood pressure was 110/70 and pulse rate was 72. Unspecified medical attention was sought and no treatment was required. Subsequently, the patient recovered from syncopal episode. Additional information has been requested.


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