Evidence dossier · candidate cand-hpv-syncope · VICP program · · DRAFT — not a determination
This is a draft research-tracking dossier, not a determination that HPV vaccine causes Syncope (Fainting), and not an incidence or legal finding. All evidence is flagged needs_human_review and must be reviewed before any page is published or cited. Every value is grounded in retrieved citations (PMID + retrieval date); unsourced items read "no evidence found / not assessable". Symmetric search: every supporting query has a mirror/null query, and zeros are shown (negative dossiers report the absence of signal).
Claim matrix (C1–C6, computed)
Claim
Label
Status
Missing nodes
C1
Coherent clinical object exists
insufficient_data
missing: A1 A2
C2
Consistent temporal window
insufficient_data
missing: A5
C3
Epidemiologic excess risk
insufficient_data
missing: B1 B3
C4
Consistency / replication
insufficient_data
missing: B5
C5
Specificity (product / dose)
insufficient_data
missing: C1n
C6
Biological mechanism
insufficient_data
missing: E1
Two evidentiary bars apply to the epi nodes/claims (C3, C4): · VICP — preponderance of the evidence. · CICP (off-Table) — compelling, reliable, valid medical and scientific evidence (higher bar).
Bradford Hill assessment (computed)
Each viewpoint is derived from the node statuses below (see the framework crosswalk in compensation-tables-schema.md §8). Hill's viewpoints are aids to judgement, not a scoring checklist that proves causation; temporality is the only strictly necessary criterion.
Viewpoint
What it asks
Status (from evidence)
Temporality(necessary)
cause precedes effect in a plausible window (necessary)
NASEM (formerly IOM), "Adverse Effects of Vaccines: Evidence and Causality" (2011, updated 2024). Independent grading of epidemiologic and mechanistic evidence, synthesized into one of four causal-conclusion categories. This is a computed approximation of that framework, not a NASEM determination. See compensation-tables-schema.md §8bis.
Case-definition standard: no established case definition (needs_human_review — not in spec §1's named-standard list) — governs the case-certainty scale on A1/A2/A6/A8 below. See compensation-tables-schema.md §8ter.
Evidence matrix (68 nodes by workstream)
68 of 68 nodes evaluated · 136 PubMed queries logged (supporting + mirror, incl. zeros). Statuses are computed from retrieved citations; not hand-set.
Definition & attribution 24/24 evaluated
A1 · Case reportsno_data
Measure: New definite object in risk window T Comparator: Pre-vaccination baseline Hit rule: Definite object present, onset in window, competing causes considered
Finding: No retrieved evidence specifically addresses syncope (fainting) as an adverse event following HPV vaccination. One general review (PMID 16871116) mentions syncope among common, mild vaccine-related adverse events in children but does not focus on HPV vaccine or assess a risk window for this outcome.
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") case report OR case series Case reports pubmed · 66200 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") alternative diagnosis OR not vaccine-related pubmed · 4053 hits · run 2026-09-09
11 retrieved record(s)
ambiguous 33647971 · QJM : monthly journal of the Association (2021) — COVID-19 vaccine-related myositis.
does_not_resolve 37775180 · Clinical medicine (London, England) (2023) — SARS-CoV-2 vaccines and myocarditis.
ambiguous 30000765 · (2006) — Human Papillomavirus Vaccines.
ambiguous 7114977 · Archives of internal medicine (1982) — Vaccine-related poliomyelitis.
A2 · Series with objective confirmationno_data
Measure: Definite object plus objective test Comparator: Reference range / diagnostic criteria Hit rule: Objective confirmation in >=1 case per the working definition
Finding: No retrieved evidence addresses HPV vaccine-related syncope with objective confirmation; the retrieved evidence includes only a mention of syncope as a mild adverse event in a general vaccination review (PMID 16871116) without specific objective confirmation or focus on HPV vaccine.
Case-certainty distribution (no established case definition): 1 Possible/unclassifiable. Transparency layer — does not change this node's status or feed C1–C6.
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") case report OR case series Series with objective confirmation pubmed · 5650 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") alternative diagnosis OR not vaccine-related pubmed · 4053 hits · run 2026-09-09
11 retrieved record(s)
ambiguous 33647971 · QJM : monthly journal of the Association (2021) — COVID-19 vaccine-related myositis.
does_not_resolve 37775180 · Clinical medicine (London, England) (2023) — SARS-CoV-2 vaccines and myocarditis.
ambiguous 30000765 · (2006) — Human Papillomavirus Vaccines.
Measure: Distribution of onset times after dose Comparator: Pre-specified risk window Hit rule: Onset clusters inside the pre-specified window (not uniform/flat)
Finding: No retrieved evidence directly addresses the onset timing or clustering of syncope (fainting) after HPV vaccination; the only mention of syncope is in a general review [PMID 16871116 2006] that lists syncope among common vaccine-related adverse events in children without specifying a causal link to HPV vaccine or an onset window.
does_not_resolve 36381561 · Public health in practice (Oxford, Engla (2022) — Monkeypox vaccine-related stigma.
does_not_resolve 36441403 · Current cardiology reports (2022) — COVID-19 Vaccine-Related Myocardial and Pericardial Inflammation.
ambiguous 32809680 · (2026) — Rubella Vaccine.
does_not_resolve 7114977 · Archives of internal medicine (1982) — Vaccine-related poliomyelitis.
A4 · Temporal plausibilityno_data
Measure: Onset latency vs object pathophysiology Comparator: Object's known natural latency Hit rule: Onset latency consistent with the object's pathophysiology
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") case report OR case series Temporal plausibility pubmed · 35 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") alternative diagnosis OR not vaccine-related pubmed · 4053 hits · run 2026-09-09
12 retrieved record(s)
does_not_resolve 15638050 · Clinical and experimental rheumatology (2004) — A case-series of adverse events, positive re-challenge of symptoms, and events in identical twins following hepatitis B vaccination: analysis of the Vaccine Adv
does_not_resolve 33647971 · QJM : monthly journal of the Association (2021) — COVID-19 vaccine-related myositis.
does_not_resolve 37775180 · Clinical medicine (London, England) (2023) — SARS-CoV-2 vaccines and myocarditis.
ambiguous 30000765 · (2006) — Human Papillomavirus Vaccines.
ambiguous 7114977 · Archives of internal medicine (1982) — Vaccine-related poliomyelitis.
A6 · Differential diagnosis excludedno_data
Measure: Competing causes assessed and excluded Comparator: Likely alternative diagnoses Hit rule: Pre-specified competing causes ruled out per the working definition
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") case report OR case series Differential diagnosis excluded pubmed · 431 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") alternative diagnosis OR not vaccine-related pubmed · 4053 hits · run 2026-09-09
11 retrieved record(s)
ambiguous 33647971 · QJM : monthly journal of the Association (2021) — COVID-19 vaccine-related myositis.
does_not_resolve 37775180 · Clinical medicine (London, England) (2023) — SARS-CoV-2 vaccines and myocarditis.
ambiguous 30000765 · (2006) — Human Papillomavirus Vaccines.
A8 · Adjudicated by criteria (no established case definition)no_data
Measure: Object adjudicated by published criteria Comparator: Published clinical / Brighton criteria Hit rule: Cases adjudicated to 'definite' by a published criterion set
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") case report OR case series Adjudicated by criteria pubmed · 43 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") alternative diagnosis OR not vaccine-related pubmed · 4053 hits · run 2026-09-09
11 retrieved record(s)
ambiguous 33647971 · QJM : monthly journal of the Association (2021) — COVID-19 vaccine-related myositis.
does_not_resolve 37775180 · Clinical medicine (London, England) (2023) — SARS-CoV-2 vaccines and myocarditis.
ambiguous 30000765 · (2006) — Human Papillomavirus Vaccines.
Measure: Course matches the object's natural history Comparator: Known natural history of the object Hit rule: Clinical course (onset, peak, recovery) matches the object's natural history
Finding: No retrieved evidence addresses the natural history of syncope (fainting) specifically following HPV vaccination; the single abstract mentioning syncope (PMID 16871116) does not provide clinical course details (onset, peak, recovery) for syncope after HPV vaccine.
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") case report OR case series Natural-history consistency pubmed · 107 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") alternative diagnosis OR not vaccine-related pubmed · 4053 hits · run 2026-09-09
11 retrieved record(s)
does_not_resolve 33647971 · QJM : monthly journal of the Association (2021) — COVID-19 vaccine-related myositis.
does_not_resolve 37775180 · Clinical medicine (London, England) (2023) — SARS-CoV-2 vaccines and myocarditis.
ambiguous 30000765 · (2006) — Human Papillomavirus Vaccines.
Measure: Not attributable to a co-occurring condition Comparator: Co-occurring illness that could produce the object Hit rule: Object not better explained by a co-occurring condition (infection, etc.)
Finding: No retrieved evidence addresses syncope after HPV vaccination; the only mention of vaccine-related syncope is in a general review of childhood vaccines (PMID 16871116), not specific to the HPV vaccine.
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") case report OR case series No confounding object pubmed · 23 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") alternative diagnosis OR not vaccine-related pubmed · 4053 hits · run 2026-09-09
12 retrieved record(s)
does_not_resolve 34312836 · Clinical pharmacology and therapeutics (2022) — Angiotensin-Converting Enzyme Inhibitors Used Concomitantly with Insulin Secretagogues and the Risk of Serious Hypoglycemia.
ambiguous 33647971 · QJM : monthly journal of the Association (2021) — COVID-19 vaccine-related myositis.
does_not_resolve 37775180 · Clinical medicine (London, England) (2023) — SARS-CoV-2 vaccines and myocarditis.
ambiguous 30000765 · (2006) — Human Papillomavirus Vaccines.
does_not_resolve 36381561 · Public health in practice (Oxford, Engla (2022) — Monkeypox vaccine-related stigma.
does_not_resolve 36441403 · Current cardiology reports (2022) — COVID-19 Vaccine-Related Myocardial and Pericardial Inflammation.
does_not_resolve 7114977 · Archives of internal medicine (1982) — Vaccine-related poliomyelitis.
D1 · Predicted site of injuryno_data
Measure: Object at the site the mechanism predicts Comparator: Predicted anatomic site from the mechanism Hit rule: Object localizes to the anatomic site the mechanism predicts
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") anatomic localization Predicted site of injury mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Predicted site of injury not consistent with mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-09
D2 · Spared structuresno_data
Measure: Structures the mechanism should spare are spared Comparator: Structures predicted unaffected Hit rule: Structures predicted spared by the mechanism are indeed spared
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") anatomic localization Spared structures mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Spared structures not consistent with mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-09
D3 · Local vs systemic distributionno_data
Measure: Distribution matches mechanism scope Comparator: Local (injection site) vs systemic expectation Hit rule: Observed distribution (local vs systemic) matches the mechanism's predicted scope
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") anatomic localization Local vs systemic distribution mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Local vs systemic distribution not consistent with mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-09
D4 · Kinetics classno_data
Measure: Onset/offset kinetics match the mechanism Comparator: Expected kinetic class (acute vs chronic) Hit rule: Onset and offset kinetics are in the class the mechanism predicts
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") anatomic localization Kinetics class mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Kinetics class not consistent with mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-09
D5 · Platform-mechanism matchno_data
Measure: Mechanism is consistent with the platform Comparator: Mechanistic expectation for the platform Hit rule: The proposed mechanism is biologically consistent with the vaccine platform
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") anatomic localization Platform-mechanism match mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Platform-mechanism match not consistent with mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-09
H3 · Targeted treatment reversesno_data
Measure: A targeted treatment reverses the object in patients Comparator: Treatment-naive / placebo Hit rule: A mechanism-directed treatment reverses the object (vs control treatment)
Finding: No evidence found. The retrieved abstract discusses reversal agents for novel oral anticoagulants, not for syncope or HPV vaccine.
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Targeted treatment reverses intervention OR treatment OR reversal pubmed · 15146614 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Targeted treatment reverses no effect intervention pubmed · 0 hits (0 hits — negative) · run 2026-09-09
1 retrieved record(s)
does_not_resolve 26937198 · Vascular health and risk management (2016) — Reversing anticoagulant effects of novel oral anticoagulants: role of ciraparantag, andexanet alfa, and idarucizumab.
I1 · No internal contradictionno_data
Measure: No node's finding contradicts another Comparator: Internal consistency across nodes Hit rule: No evaluated node directly contradicts another (coherence)
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") No internal contradiction coherence OR latency OR susceptibility pubmed · 870416 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") No internal contradiction inconsistent OR contradicts pubmed · 27618 hits · run 2026-09-09
1 retrieved record(s)
ambiguous 15578364 · Clinical infectious diseases : an offici (2004) — Varicella vaccine for susceptible adults: do it today.
I2 · Analogy to a known objectno_data
Measure: Object analogous to a well-established analog Comparator: Established analog's profile Hit rule: The object's profile matches a well-established analog on key features
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Analogy to a known object coherence OR latency OR susceptibility pubmed · 870416 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Analogy to a known object inconsistent OR contradicts pubmed · 27618 hits · run 2026-09-09
1 retrieved record(s)
does_not_resolve 2699706 · Annali italiani di chirurgia (1989) — Etiology and risk factors of melanoma.
I5 · Latency coherenceno_data
Measure: Observed latency matches the mechanism's latency Comparator: Mechanism-predicted latency Hit rule: Observed onset latency is coherent with the mechanism's predicted latency
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Latency coherence coherence OR latency OR susceptibility pubmed · 870416 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Latency coherence inconsistent OR contradicts pubmed · 27618 hits · run 2026-09-09
1 retrieved record(s)
ambiguous 15578364 · Clinical infectious diseases : an offici (2004) — Varicella vaccine for susceptible adults: do it today.
J1 · Pre-specificationno_data
Measure: Window/hit-rule pre-specified before data Comparator: Pre-specified vs post-hoc Hit rule: The risk window, object, and hit rule were pre-specified before data were seen
Finding: No evidence was found linking HPV vaccine to syncope (fainting) in the retrieved abstracts; PMID 39226489 discusses LLMs for immune-related adverse events from immune checkpoint inhibitors, and PMID 36088907 addresses drug-induced acute kidney injury risk prediction models.
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Pre-specification pre-specified OR adjudicated pubmed · 13562 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Pre-specification post-hoc OR hypothesis-generating only pubmed · 1719 hits · run 2026-09-09
2 retrieved record(s)
does_not_resolve 39226489 · Journal of clinical oncology : official (2024) — Enhancing Precision in Detecting Severe Immune-Related Adverse Events: Comparative Analysis of Large Language Models and International Classification of Disease
Measure: Contrary evidence is logged, not omitted Comparator: Support-only dossier Hit rule: Contrary / null / refuting findings are logged and shown alongside support
Finding: No evidence found. The retrieved abstracts discuss methods for detecting immune-related adverse events from immune checkpoint inhibitors and drug-induced acute kidney injury risk prediction, with no mention of syncope (fainting) after HPV vaccination.
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Contrary-evidence log pre-specified OR adjudicated pubmed · 13562 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Contrary-evidence log post-hoc OR hypothesis-generating only pubmed · 1719 hits · run 2026-09-09
2 retrieved record(s)
does_not_resolve 39226489 · Journal of clinical oncology : official (2024) — Enhancing Precision in Detecting Severe Immune-Related Adverse Events: Comparative Analysis of Large Language Models and International Classification of Disease
Measure: Claim not based on temporality alone Comparator: Sequence-only evidence Hit rule: The claim is not supported by temporal sequence alone (independent evidence exists)
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") No temporality-only claim pre-specified OR adjudicated pubmed · 13562 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") No temporality-only claim post-hoc OR hypothesis-generating only pubmed · 1719 hits · run 2026-09-09
2 retrieved record(s)
does_not_resolve 39226489 · Journal of clinical oncology : official (2024) — Enhancing Precision in Detecting Severe Immune-Related Adverse Events: Comparative Analysis of Large Language Models and International Classification of Disease
Measure: Passive-surveillance findings bounded correctly Comparator: Active-surveillance confirmation Hit rule: Passive-surveillance signals are framed as hypothesis-generating, not confirmatory
Finding: The retrieved evidence discusses enhancing detection of immune-related adverse events using LLMs and adjudication methods for acute kidney injury, but does not address syncope following HPV vaccination or passive-surveillance signal definition.
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Passive-surveillance role pre-specified OR adjudicated pubmed · 13562 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Passive-surveillance role post-hoc OR hypothesis-generating only pubmed · 1719 hits · run 2026-09-09
2 retrieved record(s)
does_not_resolve 39226489 · Journal of clinical oncology : official (2024) — Enhancing Precision in Detecting Severe Immune-Related Adverse Events: Comparative Analysis of Large Language Models and International Classification of Disease
Measure: Dose/lot exposure mapped to the object Comparator: Unmapped exposure Hit rule: Dose / lot exposure is mapped to the object where the mechanism predicts it
Finding: The retrieved evidence discusses the use of large language models to detect immune-related adverse events from immune checkpoint inhibitors and risk prediction models for drug-induced acute kidney injury, but neither study addresses HPV vaccine or syncope (fainting) as an adverse event, and no mention of dose or lot exposure mapping is made.
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Dose mapping pre-specified OR adjudicated pubmed · 13562 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Dose mapping post-hoc OR hypothesis-generating only pubmed · 1719 hits · run 2026-09-09
2 retrieved record(s)
does_not_resolve 39226489 · Journal of clinical oncology : official (2024) — Enhancing Precision in Detecting Severe Immune-Related Adverse Events: Comparative Analysis of Large Language Models and International Classification of Disease
Measure: RR/IRR vs unexposed or prior window Comparator: Unvaccinated person-time or pre-vaccination window Hit rule: RR/IRR > 1 with CI excluding 1 after pre-specified confounders
Finding: No retrieved evidence specifically addresses the risk of syncope (fainting) following HPV vaccination using a self-controlled case series or similar design. One study on HPV vaccine VAERS reports (PMID 40746171) evaluates adverse events but uses disproportionally analysis (reporting odds ratios), not the pre-specified SCCS/SCRI criteria, and does not isolate syncope as a primary outcome.
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Excess vs baseline incidence risk cohort OR self-controlled case series pubmed · 948 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") no association OR null OR no increased risk Excess vs baseline pubmed · 88528 hits · run 2026-09-09
does_not_resolve 34937500 · Expert review of vaccines (2022) — Self-controlled case series design in vaccine safety: a systematic review.
does_not_resolve 38875047 · The International journal of risk & safe (2024) — Self-controlled risk interval study of rotavirus vaccine safety: Findings and implications.
does_not_resolve 40664645 · Nature communications (2025) — Evaluating the safety of XBB.1.5-containing COVID-19 mRNA vaccines using a self-controlled case series study.
does_not_resolve 40440921 · Vaccine (2025) — Risk of Guillain-Barré syndrome after COVID-19 vaccination or SARS-CoV-2 infection: A multinational self-controlled case series study.
does_not_resolve 38388239 · Vaccine (2024) — Mortality risk after COVID-19 vaccination: A self-controlled case series study.
ambiguous 40746171 · Human vaccines & immunotherapeutics (2025) — Real-world safety of HPV vaccines over 18 y: A comprehensive analysis of U.S. VAERS reports.
does_not_resolve 34489307 · Gut (2022) — Non-alcoholic fatty liver disease and incident major adverse cardiovascular events: results from a nationwide histology cohort.
B2 · SCCSno_data
Measure: Self-controlled case series risk ratio Comparator: Individuals' own risk intervals (no-event) Hit rule: SCCS risk ratio > 1 in the post-vaccination window, CI excluding 1
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") SCCS incidence risk cohort OR self-controlled case series pubmed · 948 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") no association OR null OR no increased risk SCCS pubmed · 88637 hits · run 2026-09-09
does_not_resolve 37468475 · Nature communications (2023) — Herpes zoster vaccine safety in the Aotearoa New Zealand population: a self-controlled case series study.
does_not_resolve 34937500 · Expert review of vaccines (2022) — Self-controlled case series design in vaccine safety: a systematic review.
does_not_resolve 38875047 · The International journal of risk & safe (2024) — Self-controlled risk interval study of rotavirus vaccine safety: Findings and implications.
does_not_resolve 40664645 · Nature communications (2025) — Evaluating the safety of XBB.1.5-containing COVID-19 mRNA vaccines using a self-controlled case series study.
does_not_resolve 24700656 · Clinical infectious diseases : an offici (2014) — Risk of stroke following herpes zoster: a self-controlled case-series study.
does_not_resolve 39795956 · International journal of molecular scien (2024) — The Potential Metalloestrogenic Effect of Aluminum on Breast Cancer Risk for Antiperspirant Users.
ambiguous 40662677 · Human vaccines & immunotherapeutics (2025) — Adverse events following 9-valent human papillomavirus vaccine (GARDASIL® 9) reported to the Vaccine Adverse Event Reporting System (VAERS), 2015-2024.
B3 · Cohort / risk-intervalno_data
Measure: Incidence rate ratio in defined window Comparator: Pre-specified risk vs comparison interval Hit rule: IRR > 1 in the pre-specified window, CI excluding 1, stratified by age/sex
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Cohort / risk-interval incidence risk cohort OR self-controlled case series pubmed · 948 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") no association OR null OR no increased risk Cohort / risk-interval pubmed · 88137 hits · run 2026-09-09
does_not_resolve 37468475 · Nature communications (2023) — Herpes zoster vaccine safety in the Aotearoa New Zealand population: a self-controlled case series study.
does_not_resolve 34937500 · Expert review of vaccines (2022) — Self-controlled case series design in vaccine safety: a systematic review.
does_not_resolve 38875047 · The International journal of risk & safe (2024) — Self-controlled risk interval study of rotavirus vaccine safety: Findings and implications.
does_not_resolve 40664645 · Nature communications (2025) — Evaluating the safety of XBB.1.5-containing COVID-19 mRNA vaccines using a self-controlled case series study.
does_not_resolve 24700656 · Clinical infectious diseases : an offici (2014) — Risk of stroke following herpes zoster: a self-controlled case-series study.
ambiguous 28671426 · American family physician (2017) — Vaccine Adverse Events: Separating Myth from Reality.
does_not_resolve 23884605 · Tumour biology : the journal of the Inte (2013) — Association between glutathione S-transferase M 1 null genotype and risk of ovarian cancer: a meta-analysis.
B4 · Meta-analysis / poolingno_data
Measure: Pooled effect across studies Comparator: Pooled estimate with heterogeneity Hit rule: Pooled estimate > 1 (or < 1) with quantified heterogeneity (I2)
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Meta-analysis / pooling incidence risk cohort OR self-controlled case series pubmed · 948 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") no association OR null OR no increased risk Meta-analysis / pooling pubmed · 111995 hits · run 2026-09-09
does_not_resolve 37468475 · Nature communications (2023) — Herpes zoster vaccine safety in the Aotearoa New Zealand population: a self-controlled case series study.
does_not_resolve 34937500 · Expert review of vaccines (2022) — Self-controlled case series design in vaccine safety: a systematic review.
does_not_resolve 38875047 · The International journal of risk & safe (2024) — Self-controlled risk interval study of rotavirus vaccine safety: Findings and implications.
does_not_resolve 40664645 · Nature communications (2025) — Evaluating the safety of XBB.1.5-containing COVID-19 mRNA vaccines using a self-controlled case series study.
does_not_resolve 24700656 · Clinical infectious diseases : an offici (2014) — Risk of stroke following herpes zoster: a self-controlled case-series study.
does_not_resolve 29402646 · Journal of the American Medical Director (2018) — Fall-Risk-Increasing Drugs: A Systematic Review and Meta-analysis: III. Others.
ambiguous 40746171 · Human vaccines & immunotherapeutics (2025) — Real-world safety of HPV vaccines over 18 y: A comprehensive analysis of U.S. VAERS reports.
B5 · Negative-control outcomesno_data
Measure: No excess for outcomes the vaccine should not cause Comparator: Negative-control outcomes (unaffected by mechanism) Hit rule: Null for negative-control outcomes while target outcome is positive (specificity)
Finding: No evidence found in the retrieved abstracts specifically addressing syncope (fainting) after HPV vaccination.
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Negative-control outcomes incidence risk cohort OR self-controlled case series pubmed · 948 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") no association OR null OR no increased risk Negative-control outcomes pubmed · 88339 hits · run 2026-09-09
does_not_resolve 34937500 · Expert review of vaccines (2022) — Self-controlled case series design in vaccine safety: a systematic review.
does_not_resolve 38875047 · The International journal of risk & safe (2024) — Self-controlled risk interval study of rotavirus vaccine safety: Findings and implications.
does_not_resolve 40664645 · Nature communications (2025) — Evaluating the safety of XBB.1.5-containing COVID-19 mRNA vaccines using a self-controlled case series study.
does_not_resolve 38388239 · Vaccine (2024) — Mortality risk after COVID-19 vaccination: A self-controlled case series study.
does_not_resolve 38833248 · JAMA network open (2024) — Valproate Use During Spermatogenesis and Risk to Offspring.
B6 · Other-antigen comparisonno_data
Measure: Risk vs a different-antigen comparator Comparator: Comparator product with a different antigen Hit rule: Risk specific to the target antigen, not shared with the comparator antigen
Finding: The retrieved evidence does not address syncope (fainting) following HPV vaccination, nor does it compare risk between HPV vaccine and a different-antigen comparator; the studies focus on shingles, rotavirus, COVID-19 mRNA vaccines, and herpes zoster, with one paper on HPV vaccine safety (PMID 40746171) but without mention of syncope or a comparator-antigen design specific to this node.
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Other-antigen comparison incidence risk cohort OR self-controlled case series pubmed · 948 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") no association OR null OR no increased risk Other-antigen comparison pubmed · 88101 hits · run 2026-09-09
does_not_resolve 37468475 · Nature communications (2023) — Herpes zoster vaccine safety in the Aotearoa New Zealand population: a self-controlled case series study.
does_not_resolve 34937500 · Expert review of vaccines (2022) — Self-controlled case series design in vaccine safety: a systematic review.
refutes_node 38875047 · The International journal of risk & safe (2024) — Self-controlled risk interval study of rotavirus vaccine safety: Findings and implications.
does_not_resolve 40664645 · Nature communications (2025) — Evaluating the safety of XBB.1.5-containing COVID-19 mRNA vaccines using a self-controlled case series study.
ambiguous 24700656 · Clinical infectious diseases : an offici (2014) — Risk of stroke following herpes zoster: a self-controlled case-series study.
ambiguous 40746171 · Human vaccines & immunotherapeutics (2025) — Real-world safety of HPV vaccines over 18 y: A comprehensive analysis of U.S. VAERS reports.
B7 · Absolute riskno_data
Measure: Per-100k risk in window Comparator: Absolute incidence per 100k Hit rule: Absolute risk reported and stable across the window (not an artifact of rarity)
Finding: No retrieved evidence provides absolute risk per 100,000 for syncope (fainting) following HPV vaccination. The only HPV-related studies (PMID 40746171, 40662677) are VAERS disproportionally analyses, which do not report absolute risks in a defined risk window, and the remaining retrieved articles cover other vaccines or unrelated health outcomes.
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Absolute risk incidence risk cohort OR self-controlled case series pubmed · 948 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") no association OR null OR no increased risk Absolute risk pubmed · 111395 hits · run 2026-09-09
does_not_resolve 37468475 · Nature communications (2023) — Herpes zoster vaccine safety in the Aotearoa New Zealand population: a self-controlled case series study.
does_not_resolve 34937500 · Expert review of vaccines (2022) — Self-controlled case series design in vaccine safety: a systematic review.
does_not_resolve 38875047 · The International journal of risk & safe (2024) — Self-controlled risk interval study of rotavirus vaccine safety: Findings and implications.
does_not_resolve 40664645 · Nature communications (2025) — Evaluating the safety of XBB.1.5-containing COVID-19 mRNA vaccines using a self-controlled case series study.
does_not_resolve 24700656 · Clinical infectious diseases : an offici (2014) — Risk of stroke following herpes zoster: a self-controlled case-series study.
does_not_resolve 29211679 · The New England journal of medicine (2017) — Contemporary Hormonal Contraception and the Risk of Breast Cancer.
does_not_resolve 23484825 · The New England journal of medicine (2013) — Risk of ischemic heart disease in women after radiotherapy for breast cancer.
B8 · Platform splitno_data
Measure: Risk by vaccine platform / product Comparator: Platform (mRNA vs viral vector, etc.) Hit rule: Risk attributable to a specific platform, not to 'a vaccine' generally
Finding: The retrieved evidence does not contain any study specifically assessing syncope (fainting) following HPV vaccination. The available papers address shingles vaccines, rotavirus vaccine, COVID-19 mRNA vaccines, herpes zoster, GSTT1 genotype, topical calcineurin inhibitors, and general HPV vaccine safety reviews that do not provide platform-specific or product-specific risk estimates for syncope.
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Platform split incidence risk cohort OR self-controlled case series pubmed · 948 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") no association OR null OR no increased risk Platform split pubmed · 88166 hits · run 2026-09-09
does_not_resolve 37468475 · Nature communications (2023) — Herpes zoster vaccine safety in the Aotearoa New Zealand population: a self-controlled case series study.
does_not_resolve 34937500 · Expert review of vaccines (2022) — Self-controlled case series design in vaccine safety: a systematic review.
does_not_resolve 38875047 · The International journal of risk & safe (2024) — Self-controlled risk interval study of rotavirus vaccine safety: Findings and implications.
ambiguous 40664645 · Nature communications (2025) — Evaluating the safety of XBB.1.5-containing COVID-19 mRNA vaccines using a self-controlled case series study.
does_not_resolve 24700656 · Clinical infectious diseases : an offici (2014) — Risk of stroke following herpes zoster: a self-controlled case-series study.
does_not_resolve 19020361 · Postgraduate medicine (2008) — New quadrivalent HPV vaccine developments.
does_not_resolve 23949879 · Tumour biology : the journal of the Inte (2014) — Meta-analysis of the association between GSTT1 null genotype and risk of nasopharyngeal carcinoma in Chinese.
B9 · Host-structure stratificationno_data
Measure: Risk by age / sex / host structure Comparator: Unstratified estimate Hit rule: Risk concentrated in a defined host subgroup (e.g. young males), stable across sources
Finding: No retrieved evidence directly addresses the risk of syncope (fainting) following HPV vaccination stratified by host structure such as age or sex; the evidence focuses on other vaccines (shingles, rotavirus, COVID-19) or on HPV vaccine adverse events without specific analysis by demographic subgroups.
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Host-structure stratification incidence risk cohort OR self-controlled case series pubmed · 948 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") no association OR null OR no increased risk Host-structure stratification pubmed · 88099 hits · run 2026-09-09
does_not_resolve 37468475 · Nature communications (2023) — Herpes zoster vaccine safety in the Aotearoa New Zealand population: a self-controlled case series study.
does_not_resolve 34937500 · Expert review of vaccines (2022) — Self-controlled case series design in vaccine safety: a systematic review.
does_not_resolve 38875047 · The International journal of risk & safe (2024) — Self-controlled risk interval study of rotavirus vaccine safety: Findings and implications.
does_not_resolve 40664645 · Nature communications (2025) — Evaluating the safety of XBB.1.5-containing COVID-19 mRNA vaccines using a self-controlled case series study.
does_not_resolve 24700656 · Clinical infectious diseases : an offici (2014) — Risk of stroke following herpes zoster: a self-controlled case-series study.
ambiguous 40662677 · Human vaccines & immunotherapeutics (2025) — Adverse events following 9-valent human papillomavirus vaccine (GARDASIL® 9) reported to the Vaccine Adverse Event Reporting System (VAERS), 2015-2024.
ambiguous 26107345 · The Pediatric infectious disease journal (2015) — An Overview of Quadrivalent Human Papillomavirus Vaccine Safety: 2006 to 2015.
B10 · Formulation / component changeno_data
Measure: Risk tracks a formulation change Comparator: Pre- vs post-change formulation Hit rule: Risk change tracks a documented formulation / component change over time
Finding: The retrieved evidence does not include any studies specifically addressing the relationship between HPV vaccine formulation or component changes and the risk of syncope (fainting).
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Formulation / component change incidence risk cohort OR self-controlled case series pubmed · 948 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") no association OR null OR no increased risk Formulation / component change pubmed · 88261 hits · run 2026-09-09
does_not_resolve 37468475 · Nature communications (2023) — Herpes zoster vaccine safety in the Aotearoa New Zealand population: a self-controlled case series study.
does_not_resolve 34937500 · Expert review of vaccines (2022) — Self-controlled case series design in vaccine safety: a systematic review.
does_not_resolve 38875047 · The International journal of risk & safe (2024) — Self-controlled risk interval study of rotavirus vaccine safety: Findings and implications.
does_not_resolve 40664645 · Nature communications (2025) — Evaluating the safety of XBB.1.5-containing COVID-19 mRNA vaccines using a self-controlled case series study.
does_not_resolve 24700656 · Clinical infectious diseases : an offici (2014) — Risk of stroke following herpes zoster: a self-controlled case-series study.
does_not_resolve 40746171 · Human vaccines & immunotherapeutics (2025) — Real-world safety of HPV vaccines over 18 y: A comprehensive analysis of U.S. VAERS reports.
does_not_resolve 41092926 · Lancet (London, England) (2025) — Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 su
H2 · Formulation natural experimentno_data
Measure: Risk shifts with a formulation change in the field Comparator: Pre- vs post-change formulation Hit rule: Observed risk tracks a real-world formulation change (natural experiment)
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Formulation natural experiment intervention OR treatment OR reversal pubmed · 15146614 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Formulation natural experiment no effect intervention pubmed · 0 hits (0 hits — negative) · run 2026-09-09
H4 · Policy / pause signalno_data
Measure: Risk signal appears/disappears across a pause or policy change Comparator: Pre- vs post-pause period Hit rule: The signal appears or disappears coherently with a rollout / pause (H4)
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Policy / pause signal intervention OR treatment OR reversal pubmed · 15146614 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Policy / pause signal no effect intervention pubmed · 0 hits (0 hits — negative) · run 2026-09-09
I3 · Infection coherenceno_data
Measure: Pattern is coherent with or distinct from infection Comparator: Infection-matched comparison Hit rule: The post-vaccine pattern is coherent with (or clearly distinct from) the infection pattern
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Infection coherence coherence OR latency OR susceptibility pubmed · 870416 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Infection coherence inconsistent OR contradicts pubmed · 27618 hits · run 2026-09-09
1 retrieved record(s)
does_not_resolve 2699706 · Annali italiani di chirurgia (1989) — Etiology and risk factors of melanoma.
Mediator & biological gradient 24/24 evaluated
C1n · Dose strength gradientno_data
Measure: Risk vs dose strength (dose size) Comparator: Lower dose strength Hit rule: Monotonic dose-response in dose strength (larger dose -> higher risk)
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Dose strength gradient dose-response OR dose effect pubmed · 1299586 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") no dose effect OR no dose-response Dose strength gradient pubmed · 122 hits · run 2026-09-09
2 retrieved record(s)
does_not_resolve 39082700 · The Journal of infectious diseases (2025) — Effectiveness of MenB-4C Vaccine Against Gonorrhea: A Systematic Review and Meta-analysis.
ambiguous 23637071 · Drug safety (2013) — Safety of human papillomavirus vaccines: a review.
C2n · Dose number gradientno_data
Measure: Risk vs dose number (1st vs 2nd vs 3rd) Comparator: First dose Hit rule: Risk increases (or shows a defined pattern) with dose number
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Dose number gradient dose-response OR dose effect pubmed · 1299586 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") no dose effect OR no dose-response Dose number gradient pubmed · 567 hits · run 2026-09-09
5 retrieved record(s)
does_not_resolve 39082700 · The Journal of infectious diseases (2025) — Effectiveness of MenB-4C Vaccine Against Gonorrhea: A Systematic Review and Meta-analysis.
does_not_resolve 23637071 · Drug safety (2013) — Safety of human papillomavirus vaccines: a review.
refutes_node 31740498 · Pediatrics (2019) — Near Real-Time Surveillance to Assess the Safety of the 9-Valent Human Papillomavirus Vaccine.
does_not_resolve 30316563 · Radiotherapy and oncology : journal of t (2019) — Volume effects of radiotherapy on the risk of second primary cancers: A systematic review of clinical and epidemiological studies.
does_not_resolve 42106826 · The international journal of behavioral (2026) — Physical activity, falls, and dementia risk in adults aged ≥ 60: evidence from three cohorts.
C3n · Measured-exposure tertilesno_data
Measure: Risk vs measured exposure tertile Comparator: Lowest-exposure tertile Hit rule: Risk ordered by measured-exposure tertile (high > mid > low)
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Measured-exposure tertiles dose-response OR dose effect pubmed · 1299586 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") no dose effect OR no dose-response Measured-exposure tertiles pubmed · 11 hits · run 2026-09-09
11 retrieved record(s)
does_not_resolve 39082700 · The Journal of infectious diseases (2025) — Effectiveness of MenB-4C Vaccine Against Gonorrhea: A Systematic Review and Meta-analysis.
does_not_resolve 36396513 · Vaccine (2023) — Safety of 9-valent human papillomavirus vaccine administered to males and females in routine use.
does_not_resolve 23637071 · Drug safety (2013) — Safety of human papillomavirus vaccines: a review.
does_not_resolve 31740498 · Pediatrics (2019) — Near Real-Time Surveillance to Assess the Safety of the 9-Valent Human Papillomavirus Vaccine.
ambiguous 27295585 · Human vaccines & immunotherapeutics (2016) — Adverse events following HPV immunization in Australia: Establishment of a clinical network.
refutes_node 30118381 · Human vaccines & immunotherapeutics (2019) — HPV vaccine confidence and cases of mass psychogenic illness following immunization in Carmen de Bolivar, Colombia.
ambiguous 19374268 · Communicable diseases intelligence quart (2008) — Annual report: surveillance of adverse events following immunisation in Australia, 2007.
does_not_resolve 33271094 · The Lancet. Oncology (2020) — Pembrolizumab plus GX-188E therapeutic DNA vaccine in patients with HPV-16-positive or HPV-18-positive advanced cervical cancer: interim results of a single-arm
C4n · Organoid concentration curveno_data
Measure: Effect vs antigen concentration in organoid Comparator: Vehicle / zero antigen Hit rule: Dose-dependent effect across a graded concentration curve
Finding: No retrieved evidence addresses a dose-dependent effect of HPV vaccine antigen concentration on syncope (fainting) in an organoid model.
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Organoid concentration curve dose-response OR dose effect pubmed · 1299586 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") no dose effect OR no dose-response Organoid concentration curve pubmed · 22 hits · run 2026-09-09
8 retrieved record(s)
does_not_resolve 39082700 · The Journal of infectious diseases (2025) — Effectiveness of MenB-4C Vaccine Against Gonorrhea: A Systematic Review and Meta-analysis.
ambiguous 23637071 · Drug safety (2013) — Safety of human papillomavirus vaccines: a review.
refutes_node 31740498 · Pediatrics (2019) — Near Real-Time Surveillance to Assess the Safety of the 9-Valent Human Papillomavirus Vaccine.
does_not_resolve 27295585 · Human vaccines & immunotherapeutics (2016) — Adverse events following HPV immunization in Australia: Establishment of a clinical network.
ambiguous 19374268 · Communicable diseases intelligence quart (2008) — Annual report: surveillance of adverse events following immunisation in Australia, 2007.
ambiguous 36396513 · Vaccine (2023) — Safety of 9-valent human papillomavirus vaccine administered to males and females in routine use.
does_not_resolve 33271094 · The Lancet. Oncology (2020) — Pembrolizumab plus GX-188E therapeutic DNA vaccine in patients with HPV-16-positive or HPV-18-positive advanced cervical cancer: interim results of a single-arm
refutes_node 30118381 · Human vaccines & immunotherapeutics (2019) — HPV vaccine confidence and cases of mass psychogenic illness following immunization in Carmen de Bolivar, Colombia.
C5n · EC50 vs Cmax coherenceno_data
Measure: Measured exposure reaches effect threshold Comparator: Pharmacokinetic Cmax vs EC50 Hit rule: Achieved exposure (Cmax/tissue) plausibly reaches the in-vitro EC50
Finding: No retrieved evidence addresses whether achieved Cmax/tissue concentrations of HPV vaccine plausibly reach in-vitro EC50 for syncope (fainting).
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") EC50 vs Cmax coherence dose-response OR dose effect pubmed · 1299586 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") no dose effect OR no dose-response EC50 vs Cmax coherence pubmed · 11 hits · run 2026-09-09
11 retrieved record(s)
does_not_resolve 39082700 · The Journal of infectious diseases (2025) — Effectiveness of MenB-4C Vaccine Against Gonorrhea: A Systematic Review and Meta-analysis.
does_not_resolve 23637071 · Drug safety (2013) — Safety of human papillomavirus vaccines: a review.
does_not_resolve 31740498 · Pediatrics (2019) — Near Real-Time Surveillance to Assess the Safety of the 9-Valent Human Papillomavirus Vaccine.
ambiguous 36396513 · Vaccine (2023) — Safety of 9-valent human papillomavirus vaccine administered to males and females in routine use.
ambiguous 19374268 · Communicable diseases intelligence quart (2008) — Annual report: surveillance of adverse events following immunisation in Australia, 2007.
does_not_resolve 33271094 · The Lancet. Oncology (2020) — Pembrolizumab plus GX-188E therapeutic DNA vaccine in patients with HPV-16-positive or HPV-18-positive advanced cervical cancer: interim results of a single-arm
does_not_resolve 30118381 · Human vaccines & immunotherapeutics (2019) — HPV vaccine confidence and cases of mass psychogenic illness following immunization in Carmen de Bolivar, Colombia.
supports_node 23027469 · Archives of pediatrics & adolescent medi (2012) — Safety of quadrivalent human papillomavirus vaccine administered routinely to females.
E1 · Mediator identified in casesno_data
Measure: Mediator present in affected tissue/cells Comparator: Unaffected tissue / control Hit rule: The hypothesized mediator is detected in the affected compartment and not (or less) in control
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") mechanism Mediator identified in cases in vitro OR patient-derived pubmed · 29266 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Mediator identified in cases not associated mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-09
E2 · Mediator in healthy vaccineesno_data
Measure: Mediator detectable after vaccination Comparator: Pre-vaccination baseline Hit rule: Mediator appears after vaccination and tracks the exposure window
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") mechanism Mediator in healthy vaccinees in vitro OR patient-derived pubmed · 29266 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Mediator in healthy vaccinees not associated mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-09
E3 · Infection contrastno_data
Measure: Mediator absent/low after natural infection Comparator: Recovered natural infection Hit rule: Mediator signal is specific to vaccination vs a comparable natural-infection control
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") mechanism Infection contrast in vitro OR patient-derived pubmed · 29266 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Infection contrast not associated mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-09
E4 · Transfer to recipientno_data
Measure: Phenotype/mediator transferred to a recipient system Comparator: Control transfer Hit rule: The effect / mediator transfers to a naive recipient system
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") mechanism Transfer to recipient in vitro OR patient-derived pubmed · 29266 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Transfer to recipient not associated mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-09
E5 · Transfer specificityno_data
Measure: Transfer requires the specific mediator Comparator: Transfer with mediator present Hit rule: Transfer effect is lost when the specific mediator is removed
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") mechanism Transfer specificity in vitro OR patient-derived pubmed · 29266 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Transfer specificity not associated mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-09
E6 · Depletion / knockdownno_data
Measure: Removing the mediator reduces the effect Comparator: Non-targeted knockdown Hit rule: Knockdown / depletion of the mediator reduces the phenotype
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") mechanism Depletion / knockdown in vitro OR patient-derived pubmed · 29266 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Depletion / knockdown not associated mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-09
E7 · Add-back rescueno_data
Measure: Adding the mediator restores the effect Comparator: Add-back of a control protein Hit rule: Adding back the mediator (not a control) restores the phenotype
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") mechanism Add-back rescue in vitro OR patient-derived pubmed · 29266 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Add-back rescue not associated mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-09
E8 · Neutralizationno_data
Measure: Neutralizing the mediator blocks the effect Comparator: Isotype control Hit rule: Neutralization of the mediator (not an isotype control) blocks the phenotype
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") mechanism Neutralization in vitro OR patient-derived pubmed · 29266 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Neutralization not associated mechanism pubmed · 1 hits · run 2026-09-09
E9 · Isotype controlno_data
Measure: Isotype control does not reproduce the effect Comparator: Active antibody Hit rule: An isotype control fails to reproduce the block/activation
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") mechanism Isotype control in vitro OR patient-derived pubmed · 29266 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Isotype control not associated mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-09
F1 · Full product reproducesno_data
Measure: Full vaccine product reproduces the effect Comparator: No-product control Hit rule: The full product (not a subcomponent) reproduces the effect
Finding: The retrieved evidence discusses viral-vectored and DNA vaccine platform technologies for diseases such as avian influenza, malaria, and COVID-19, but does not address HPV vaccine or syncope (fainting) in any context.
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Full product reproduces component OR antigen OR vector pubmed · 2045722 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Full product reproduces no effect component isolation pubmed · 0 hits (0 hits — negative) · run 2026-09-09
does_not_resolve 15174971 · Expert opinion on biological therapy (2004) — Particle-mediated DNA vaccine delivery to the skin.
does_not_resolve 29550258 · Immunology letters (2018) — Live bacterial vaccine vector and delivery strategies of heterologous antigen: A review.
does_not_resolve 25876176 · Human vaccines & immunotherapeutics (2015) — Progress on adenovirus-vectored universal influenza vaccines.
does_not_resolve 25142448 · Current gene therapy (2014) — Improving DNA vaccine performance through vector design.
does_not_resolve 27384578 · Viruses (2016) — Newcastle Disease Virus as a Vaccine Vector for Development of Human and Veterinary Vaccines.
F2 · Empty vector / particleno_data
Measure: Vector/particle without antigen reproduces (or not) Comparator: Full product Hit rule: Effect attributed to (or excluded from) the vector/particle backbone alone
Finding: No evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Empty vector / particle component OR antigen OR vector pubmed · 2045722 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Empty vector / particle no effect component isolation pubmed · 0 hits (0 hits — negative) · run 2026-09-09
does_not_resolve 15174971 · Expert opinion on biological therapy (2004) — Particle-mediated DNA vaccine delivery to the skin.
does_not_resolve 29550258 · Immunology letters (2018) — Live bacterial vaccine vector and delivery strategies of heterologous antigen: A review.
does_not_resolve 25876176 · Human vaccines & immunotherapeutics (2015) — Progress on adenovirus-vectored universal influenza vaccines.
does_not_resolve 25142448 · Current gene therapy (2014) — Improving DNA vaccine performance through vector design.
does_not_resolve 27384578 · Viruses (2016) — Newcastle Disease Virus as a Vaccine Vector for Development of Human and Veterinary Vaccines.
F3 · Antigen alone reproducesno_data
Measure: Isolated antigen reproduces the effect Comparator: Vehicle Hit rule: The isolated antigen (not the full product) reproduces the effect
Finding: No evidence found: The retrieved abstracts discuss viral vector vaccines for influenza, rabies, and cancer, and a measles vaccine, but none mention HPV vaccine or syncope (fainting).
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Antigen alone reproduces component OR antigen OR vector pubmed · 2045722 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Antigen alone reproduces no effect component isolation pubmed · 0 hits (0 hits — negative) · run 2026-09-09
does_not_resolve 25876176 · Human vaccines & immunotherapeutics (2015) — Progress on adenovirus-vectored universal influenza vaccines.
does_not_resolve 40857335 · PLoS neglected tropical diseases (2025) — Novel rabies vaccine candidates development based on pseudotyped lentiviral vectors with rabies virus glycoprotein.
does_not_resolve 21952287 · Cancer journal (Sudbury, Mass.) (2011) — Viral vector-based therapeutic cancer vaccines.
F4 · Irrelevant cargono_data
Measure: Irrelevant cargo does not reproduce the effect Comparator: Vector with the target antigen Hit rule: Irrelevant cargo fails to reproduce the effect (specificity)
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Irrelevant cargo component OR antigen OR vector pubmed · 2045722 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Irrelevant cargo no effect component isolation pubmed · 0 hits (0 hits — negative) · run 2026-09-09
does_not_resolve 15174971 · Expert opinion on biological therapy (2004) — Particle-mediated DNA vaccine delivery to the skin.
does_not_resolve 29550258 · Immunology letters (2018) — Live bacterial vaccine vector and delivery strategies of heterologous antigen: A review.
does_not_resolve 25876176 · Human vaccines & immunotherapeutics (2015) — Progress on adenovirus-vectored universal influenza vaccines.
does_not_resolve 25142448 · Current gene therapy (2014) — Improving DNA vaccine performance through vector design.
does_not_resolve 27384578 · Viruses (2016) — Newcastle Disease Virus as a Vaccine Vector for Development of Human and Veterinary Vaccines.
F5 · Infection preparationno_data
Measure: Infection preparation vs product comparison Comparator: Product-derived preparation Hit rule: Effect compares correctly between infection and product preparations
Finding: The retrieved evidence discusses viral vectors, DNA vaccines, and plant-based vaccine platforms, but none of the retrieved PMIDs address syncope (fainting) after HPV vaccination or provide comparisons of infection preparation versus product preparation for adverse events.
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Infection preparation component OR antigen OR vector pubmed · 2045722 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Infection preparation no effect component isolation pubmed · 0 hits (0 hits — negative) · run 2026-09-09
does_not_resolve 15174971 · Expert opinion on biological therapy (2004) — Particle-mediated DNA vaccine delivery to the skin.
does_not_resolve 29550258 · Immunology letters (2018) — Live bacterial vaccine vector and delivery strategies of heterologous antigen: A review.
does_not_resolve 25876176 · Human vaccines & immunotherapeutics (2015) — Progress on adenovirus-vectored universal influenza vaccines.
does_not_resolve 25142448 · Current gene therapy (2014) — Improving DNA vaccine performance through vector design.
does_not_resolve 27384578 · Viruses (2016) — Newcastle Disease Virus as a Vaccine Vector for Development of Human and Veterinary Vaccines.
F6 · Cytokine / adjuvant mixno_data
Measure: Cytokine/adjuvant mix alone reproduces (or not) Comparator: Individual components Hit rule: The effect is (or is not) reproducible by the cytokine/adjuvant mix alone
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Cytokine / adjuvant mix component OR antigen OR vector pubmed · 2045722 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Cytokine / adjuvant mix no effect component isolation pubmed · 0 hits (0 hits — negative) · run 2026-09-09
does_not_resolve 25876176 · Human vaccines & immunotherapeutics (2015) — Progress on adenovirus-vectored universal influenza vaccines.
does_not_resolve 40857335 · PLoS neglected tropical diseases (2025) — Novel rabies vaccine candidates development based on pseudotyped lentiviral vectors with rabies virus glycoprotein.
does_not_resolve 21952287 · Cancer journal (Sudbury, Mass.) (2011) — Viral vector-based therapeutic cancer vaccines.
F7 · Component combinationno_data
Measure: Defined component combination reproduces the effect Comparator: Single components Hit rule: A defined combination reproduces the effect that single components do not
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Component combination component OR antigen OR vector pubmed · 2045722 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Component combination no effect component isolation pubmed · 0 hits (0 hits — negative) · run 2026-09-09
does_not_resolve 25876176 · Human vaccines & immunotherapeutics (2015) — Progress on adenovirus-vectored universal influenza vaccines.
does_not_resolve 40857335 · PLoS neglected tropical diseases (2025) — Novel rabies vaccine candidates development based on pseudotyped lentiviral vectors with rabies virus glycoprotein.
does_not_resolve 21952287 · Cancer journal (Sudbury, Mass.) (2011) — Viral vector-based therapeutic cancer vaccines.
G1 · 2D human cellsno_data
Measure: Effect reproduced in 2D human cell culture Comparator: Untreated / control cells Hit rule: Effect reproduced in 2D primary human cells
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") 2D human cells animal OR organoid OR cell model pubmed · 1819354 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") 2D human cells not reproduced model pubmed · 0 hits (0 hits — negative) · run 2026-09-09
G2 · Organoid / chipno_data
Measure: Effect reproduced in organoid / organ-on-chip Comparator: Unexposed organoid Hit rule: Effect reproduced in a 3D organoid / organ-on-chip system
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Organoid / chip animal OR organoid OR cell model pubmed · 1819354 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Organoid / chip not reproduced model pubmed · 0 hits (0 hits — negative) · run 2026-09-09
H1 · Block in vitro / in vivono_data
Measure: Blocking the mediator/mechanism prevents the effect Comparator: Control intervention Hit rule: Blocking the mechanism prevents or reverses the effect (not with a control intervention)
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Block in vitro / in vivo intervention OR treatment OR reversal pubmed · 15146614 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Block in vitro / in vivo no effect intervention pubmed · 0 hits (0 hits — negative) · run 2026-09-09
1 retrieved record(s)
does_not_resolve 26937198 · Vascular health and risk management (2016) — Reversing anticoagulant effects of novel oral anticoagulants: role of ciraparantag, andexanet alfa, and idarucizumab.
Clinical / animal / host 7/7 evaluated
E10 · Host-line dependenceno_data
Measure: Effect depends on host line/cell type Comparator: Susceptible host line Hit rule: Effect is restricted to a defined host line / genotype, not universal
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") mechanism Host-line dependence in vitro OR patient-derived pubmed · 29266 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Host-line dependence not associated mechanism pubmed · 0 hits (0 hits — negative) · run 2026-09-09
G3 · Animal, clinical routeno_data
Measure: Effect in animal via the clinical route of administration Comparator: Vehicle, same route Hit rule: Effect reproduced in an animal using the clinical route of administration
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Animal, clinical route animal OR organoid OR cell model pubmed · 1819354 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Animal, clinical route not reproduced model pubmed · 0 hits (0 hits — negative) · run 2026-09-09
G4 · Susceptible animalno_data
Measure: Effect in a susceptible animal model Comparator: Non-susceptible model Hit rule: Effect in a defined susceptible animal model
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Susceptible animal animal OR organoid OR cell model pubmed · 1819355 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Susceptible animal not reproduced model pubmed · 1 hits · run 2026-09-09
G5 · Replication across labsno_data
Measure: Effect replicated in an independent lab Comparator: Original result Hit rule: The key effect is replicated in an independent laboratory
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Replication across labs animal OR organoid OR cell model pubmed · 1819354 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Replication across labs not reproduced model pubmed · 0 hits (0 hits — negative) · run 2026-09-09
G6 · Blinded scoringno_data
Measure: Outcomes scored blinded Comparator: Unblinded reference Hit rule: Primary outcomes scored by a blinded assessor
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Blinded scoring animal OR organoid OR cell model pubmed · 1819354 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Blinded scoring not reproduced model pubmed · 0 hits (0 hits — negative) · run 2026-09-09
G7 · Experimental time courseno_data
Measure: Effect follows a defined experimental time course Comparator: No-exposure time course Hit rule: The effect's onset/offset follows a defined experimental time course
Finding: no evidence found
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Experimental time course animal OR organoid OR cell model pubmed · 1819354 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Experimental time course not reproduced model pubmed · 0 hits (0 hits — negative) · run 2026-09-09
I4 · Susceptibility traitno_data
Measure: A host trait / marker defines susceptibility Comparator: Trait-negative hosts Hit rule: A defined host trait / marker enriches for susceptibility
Finding: No retrieved evidence addresses a host trait or marker that enriches for susceptibility to syncope after HPV vaccination; the papers discuss measles vaccine efficacy modeling and melanoma risk factors.
Cited: (none)
supporting: HPV vaccine (syncope OR fainting OR "vasovagal") Susceptibility trait coherence OR latency OR susceptibility pubmed · 870416 hits · run 2026-09-09
mirror: HPV vaccine (syncope OR fainting OR "vasovagal") Susceptibility trait inconsistent OR contradicts pubmed · 27618 hits · run 2026-09-09
2 retrieved record(s)
does_not_resolve 8550283 · International journal of epidemiology (1995) — Minimum attack rate for measuring measles vaccine efficacy.
does_not_resolve 2699706 · Annali italiani di chirurgia (1989) — Etiology and risk factors of melanoma.
How this was built
Per node: a supporting and a mirror PubMed query built from the node's measure / population / comparator / hit_rule; top hits fetched (title + abstract); each record classified (supports / refutes / ambiguous) by xAI with a heuristic fallback; a per-node synthesis is generated strictly from the retrieved PMIDs; the node status is then rolled up to C1–C6. Full query provenance is shown per node above. Reproduce the build: python -m evidence_run. Data: data/evidence_run/state.json.