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This is VAERS ID 284774

Case Details

VAERS ID: 284774 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: California  
Vaccinated:2007-07-13
Onset:2007-07-13
   Days after vaccination:0
Submitted: 2007-07-13
   Days after onset:0
Entered: 2007-07-16
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 01874 / 1 LA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2223AA / 1 RA / UN

Administered by: Public       Purchased by: Unknown
Symptoms: Immediate post-injection reaction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), 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:
Current Illness: None
Preexisting Conditions: Hx Allergic Rhinitis/Hx Syncope/Near Syncope Vasovagal Dx cleared by cardiology
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Syncope immediately post vaccination (Most likely vasovagal)


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