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This is VAERS ID 284550

Case Details

VAERS ID: 284550 (history)  
Age: 17.0  
Gender: Female  
Location: Unknown  
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. - / 0 - / IM
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Unknown       Purchased by: Unknown
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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0706USA00022

Write-up: Information has been received from a nurse practitioner concerning a 17 year old female who on 16-MAY-2007 was vaccinated with her first dose of Gardasil. Concomitant therapy included Menactra. On 16-MAY-2007 the patient fainted. Subsequently, the patient recovered from fainted. Additional information has been requested. 10/08/07 This is in follow-up to report(s) previously submitted on 6/14/2007. Information has been received from a nurse practitioner concerning a 17 year old female who on 16-MAY-2007 was vaccinated with her first dose of GARDASIL (lot # unknown). Concomitant therapy included MENACTRA given on the same day. On 16-MAY-2007 the patient fainted after being vaccinated. Medical attention was sought. On 16-MAY-2007 the patient recovered. Therapy was discontinued. Further information is not available.


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