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This is VAERS ID 542913

Case Details

VAERS ID: 542913 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Foreign  
Vaccinated:2014-03-29
Onset:2014-03-29
   Days after vaccination:0
Submitted: 2014-09-08
   Days after onset:163
Entered: 2014-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J011180 / 1 UN / IM

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? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Immunisation; Syncope
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1409BRA002927

Write-up: This spontaneous report was received from a Physician refers to a 12 year old female patient who experienced syncope. On 29-MAR-2014, the patient was vaccinated with GARDASIL. On 29-MAR-2014 the patient experienced Syncope fifteen (15) minutes after Vaccination. The Outcome of adverse event Syncope was reported as Recovered. The relationship of Syncope with GARDASIL is Unknown. Additional information is not expected.


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