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This is VAERS ID 284502

Case Details

VAERS ID: 284502 (history)  
Form: Version 1.0  
Age: 17.0  
Gender: Female  
Location: Unknown  
Submitted: 2007-06-14
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: 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: See Additional Page
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Refer to Additional Page
CDC Split Type: WAES0705USA05322

Write-up: Information has been received from a physician concerning a female patient between 17 and 18 years old who was vaccinated with Gardasil. The patient fainted after her first administration of Gardasil. She had also had her blood drawn at the same time and also received a dose of Menactra. The patient recovered. No other information was reported. Continued on Additional Page

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