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This is VAERS ID 411211

Case Details

VAERS ID: 411211 (history)  
Age: 12.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2010-12-02
Onset:2010-12-02
   Days after vaccination:0
Submitted: 2010-12-02
   Days after onset:0
Entered: 2010-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3576AA / 0 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0766Z / 1 RA / IM

Administered by: Public       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
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NONE
Diagnostic Lab Data: none
CDC Split Type:

Write-up: syncope


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