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This is VAERS ID 284468

Case Details

VAERS ID: 284468 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Michigan  
   Days after vaccination:0
Submitted: 2007-06-14
   Days after onset:37
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Immediate post-injection reaction, Laceration, Suture insertion, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), 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: Ear tube insertion
Diagnostic Lab Data: None
CDC Split Type: WAES0705USA04339

Write-up: Information has been received from a licensed practical nurse concerning a 15 year old female with a history of ear tube surgery as a child and with no known drug allergies who on 08-MAY-2007 was vaccinated IM with a first 0.5 ml dose of Gardasil (Lot# 654540/1161F). The patient fainted 7 to 10 minutes after receiving the vaccine and sustained a laceration of her lower lip. The laceration was repaired in the office by placement of 4 sutures. On 14-MAY-2007, the sutures were removed, the laceration was completely healed without complication and the patient fully recovered. No laboratory diagnostic studies were performed. No product quality complaint was involved. Additional information has been requested.

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