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This is VAERS ID 284535

Case Details

VAERS ID: 284535 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Washington  
   Days after vaccination:1
Submitted: 2007-06-14
   Days after onset:19
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 - / -

Administered by: Other       Purchased by: Other
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? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Lightheadedness
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0705USA05726

Write-up: Information has been received from a Nurse Practitioner concerning a 13 year old female with a history of lightheadedness who on 25-MAY-2007 was vaccinated with the first dose of Gardasil 0.5 ml. Concomitant therapy included DTaP (unspecified) and Menactra. The physician reported that the patient fainted the day after receiving the vaccine. The patient was sitting and fainted when she stood up. The patient sought unspecified medical attention. As of 30-MAY-2007 the patient had recovered. Additional information has been requested.

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