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This is VAERS ID 284504

Case Details

VAERS ID: 284504 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: New York  
Vaccinated:2007-04-30
Onset:2007-04-30
   Days after vaccination:0
Submitted: 2007-06-14
   Days after onset:45
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0387U / 2 UN / IM

Administered by: Private       Purchased by: Public
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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0705USA05336

Write-up: 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 12 year old female student with no medical history who on 30-APR-2007 received her second IM dose of GARDASIL, lot #657621/0387U. The immunization was followed by a warm sensation all over. The patient laid down for 10 minutes and felt better with no further incident. No treatment was necessary. She was reported as recovered after an unspecified time. Additional information is not expected.


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