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This is VAERS ID 284484

Case Details

VAERS ID: 284484 (history)  
Form: Version 1.0  
Age: 20.0  
Gender: Female  
Location: Missouri  
   Days after vaccination:1
Submitted: 2007-06-14
   Days after onset:36
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0387U / 1 - / IJ

Administered by: Private       Purchased by: Private
Symptoms: Pallor, 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: blood pressure, 05/09/07, 80/40; blood pressure 05/09/07 100/6
CDC Split Type: WAES0705USA04575

Write-up: Information has been received from a nurse concerning an 18 year old female who on 09-MAY-2007 was vaccinated with the first dose of Gardasil (Lot # 657621/0387U). On 09-MAY-2007 the patient fainted after receiving the first dose of Gardasil. On 09-May-2007, the patient was apprehansive about getting a shot and she had two freinds with her for support. The patient received the injection and did fine, she sat in the exam room, then went out to the waiting room to wait 20 minutes with her freinds. The receptionist called for the nurse as the patient felt faint. The patient appeared pale and fainted while sitting in chair. A cold wet towel was placed on the patient''s face and the patient woke up. The patient was taken back to an exam room and laid down. Her vital signs were taken and blood pressue was 80/40 and then 100/64. The patient was given pretzels and fluid. The nurse reported that the patient had not eaten that am. Subsequently on 09-May-2007, the patient recovered from fainting. Unspecified medical attention was sought. No additional information was provided. Additional information has been requested. Additional information is not expected.

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