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This is VAERS ID 284506

Case Details

VAERS ID: 284506 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: New York  
   Days after vaccination:0
Submitted: 2007-06-14
   Days after onset:43
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

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
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: None
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0705USA05338

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 IM 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. 10/08/07 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 with no medical history who on 02-MAY-2007 at 11:30 a.m. was vaccinated IM with her first dose of GARDASIL, lot #657621/0387U. At 11:30 a.m. she gathered her belongings, walked into the hallway, and fainted to the floor. She laid in the hallway for approximately 10 minutes, had orange juice, felt better and left the office. No treatment was necessary. She was reported as recovered on 02-MAY-2007. Additional information is not expected.

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