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This is VAERS ID 284505

Case Details

VAERS ID: 284505 (history)  
Age: 17.0  
Gender: Female  
Location: New York  
Vaccinated:2007-04-28
Onset:2007-04-28
   Days after vaccination:0
Submitted: 2007-06-14
   Days after onset:47
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0384U / 0 UN / IM

Administered by: Private       Purchased by: Private
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
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type: WAES0705USA05337

Write-up: Initial 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 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. Initial and follow up information has been received from a physician, a nurse and a healthcare professional, concerning a 17 year old, female student, with no significant medical history and no known allergies, who was vaccinated IM, on 26-APR-2007 at 1:15pm, with the first dose of GARDASIL (Lot #65617/0384U). There was no illness at the time of vaccination. It was reported that the patient felt lightheaded immediately (at 3:15pm) after receiving the injection and sat, or was laid on the floor. It was confirmed that the patient had recovered on the same day, 26-APR-2007. No further information is expected.


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