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This is VAERS ID 284525

Case Details

VAERS ID: 284525 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: Ohio  
Vaccinated:2007-05-16
Onset:2007-05-16
   Days after vaccination:0
Submitted: 2007-06-14
   Days after onset:29
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Private       Purchased by: Other
Symptoms: Pallor, 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: WAES0705USA05692

Write-up: Information has been received from a registered nurse concerning a 14 year old female who "two weeks ago" on 16-MAY-2007 was vaccinated with her first dose of Gardasil 0.5 ml intramuscularly. After receiving the vaccination on 16-MAY-2007, the patient turned white, grabbed her mother''s arm and then fainted. Subsequently, the patient recovered. Additional information has been requested.


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