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This is VAERS ID 321093

(NOTE: This result is from the 12/8/2009 version of the VAERS database)

Case Details

VAERS ID: 321093 (history)  
Form: Version .0  
Age: 13.0  
Gender: Female  
Location: Tennessee  
Vaccinated:2008-07-23
Onset:2008-07-23
   Days after vaccination:0
Submitted: 2008-08-01
   Days after onset:9
Entered: 2008-08-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER 1740U 8/10 / 1 RA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Fall, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: After receiving Gardasil patient fainted and fell to floor. Patient''s vital signs were taken and monitored for about 30 mins after episode.


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Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20091208&IDNUMBER=321093


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