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This is VAERS ID 284507

Case Details

VAERS ID: 284507 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: New York  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2007-06-14
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0384U / 1 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (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
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0705USA05339

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.This is in follow-up to report (s) previously submitted on 6/14/2007. Follow-up information has been received from a healthcare professional concerning the 14 year old female student who on 26-Apr-2007 at 2:15 p.m. received her first IM dose of GARDASIL, LOT # 657617/0384u. At 2:15 p.m. the patient experienced dizziness (also reported as within 5 minutes of receiving immunization patient excperienced dizziness). The patient laid down on the exam table and was "within normal limits after 10 minutes on the table". No treatment was necessary. Addional information is not expected.


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