Information has been received from a physician. The physician who reported this did not administer the dose of GARDASIL vaccine to this patient and therefore does not know if this was reported already by the physician who did administer it.  It was reported that a female patient was very nervous about receiving their second dose of GARDASIL and told the physician several times that she was going to faint.  After receiving the vaccine she became very pale, fainted and became very rigid.  The physician noted that it was not a seizure.  The patient was sent to the emergency room but it is not known if she was admitted to the hospital.  Subsequently, the patient recovered.  Additional information has been requested. This is in follow-up to report(s) previously submitted on 12/12/2008. Follow up information has been received from a Nurse Practitioner and medical records reporting that the patient, a 15 year old non-smoker with no known allergies, was vaccinated with the first dose of GARDASIL at 11:35 on 12-AUG-2008. The patient was vaccinated with the second dose of GARDASIL at 18:10 on 20-OCT-2008 (lot no. 661530/0575X). Concomitant therapy included the flu vaccine (lot no. u2804AA) on 20-OCT-2008. Concomitant medication included an unspecified acne medication. Just after receiving vaccination for GARDASIL and flu shot, the patient suffered a syncopal episode in the doctor's office. The patient fainted. She suffered no trauma with this episode. When recovered she became nauseated and dizzy. Just after the episode nurses took her vital signs and found her with a blood pressure 116/70, pulse rate 70 and oxygen saturation 100%. The patient was feeling a little queasy and now she felt better. The patient had no headache or chest pain or abdominal pain. She was currently menstruating. There had been no history of heavy bleeding or anemia, the patient has had no history of hypoglycemia or metabolic disturbance. There had been no recent history of vomiting or diarrhea. The patient was otherwise healthy. The patient was sent to the emergency room for further evaluation. It was reported on the medical records that "Constitutional symptoms: no fever, no chills. Past medical history: Unremarkable. Medications: Medication for acne. Allergies: No Known drug allergies. FH: Noncontributory. Social history: No smoking, no drinking, no illicit drug use. Physical exam: Thin female teenager in no acute distress. Vital Signal: temperature 98.7, pulse rate 60, respirations 19, blood pressure 118/67, oxygen saturation 97% on room air. Neuro: intact and non-focal motor, DTR and cranial nerve examination. Light touch sensation intact throughout. Normal gait. Accu-Chek reveals a serum glucose of 98. Intervention: The patient was placed on cardiac monitor. No ectopy or arrhythmia were seen. Vital signs at 2005 revealed blood pressure 111/61, pulse rate 70, oxygen saturation 100%. Discussion: Risk of complications and morbidity if untreated are potentially moderate. Differential diagnosis was considered for syncope from noxious stimuli i.e, vaccination injection. Diagnosis: Syncopal episode. Disposition: The patient is discharged in stable condition. Parents were given printed ACI. She should follow up within 1 to 2 days if symptoms recur." No further information is available.