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This is VAERS ID 275509

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

Case Details

VAERS ID: 275509 (history)  
Form: Version .0  
Age: 13.0  
Sex: Female  
Location: Unknown  
Submitted: 2007-04-02
Entered: 2007-04-03
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Public       Purchased by: Other
Symptoms: Electrocardiogram QT prolonged, Heart rate increased, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Torsade de pointes, shock-associated conditions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: electrocardiogram - prolonged Q-T, total heartbeat count over
CDC Split Type: WAES0703USA04642

Write-up: Information has been received from a nurse practitioner concerning a 13 year old female who on an unspecified date was vaccinated with first dose, single dose vial, of Gardasil (lot # not reported) IM injection. On an unspecified date, within 10 minutes of receiving the vaccination, the patient passed out. The patient''s heart rate was over 200. The patient passed out a total of three times. Medical attention was sought. The patient was hospitalized as a result of the experience. At the time of reporting, the patient had prolonged Q-T and was being seen by a cardiologist for the condition. The outcome of the events was unknown. The reporter considered the events to be immediately life-threatening. Additional information has been requested.

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