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This is VAERS ID 262242

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

262242
VAERS Form:
Age:14.0
Gender:Female
Location:Washington
Vaccinated:2006-08-23
Onset:2006-08-23
Submitted:2006-08-28
Entered:2006-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0706R / 1 LA / IM
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0637F / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Fall, Fracture, Syncope vasovagal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Vasovagal syncope shortly after receiving hep A and Gardasil vaccine, fell, hit nose on a drawer, loss of consciousness, sent to ER in transport broke nose.


Changed on 12/8/2009

262242 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Washington
Vaccinated:2006-08-23
Onset:2006-08-23
Submitted:2006-08-28
Entered:2006-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) HEP A (VAQTA) / MERCK & CO. INC. 0706R / 1 LA / IM
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. 0637F / 0 LA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Fall, Fracture, Syncope vasovagal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Vasovagal syncope shortly after receiving hep A and Gardasil vaccine, fell, hit nose on a drawer, loss of consciousness, sent to ER in transport broke nose.


Changed on 5/14/2017

262242 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Washington
Vaccinated:2006-08-23
Onset:2006-08-23
Submitted:2006-08-28
Entered:2006-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0706R / 1 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Fall, Fracture, Injury, Loss of consciousness, Syncope vasovagal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Vasovagal syncope shortly after receiving hep A and Gardasil vaccine, fell, hit nose on a drawer, loss of consciousness, sent to ER in transport broke nose.


Changed on 9/14/2017

262242 Before After
VAERS Form:(blank) 1
Age:14.0
Gender:Female
Location:Washington
Vaccinated:2006-08-23
Onset:2006-08-23
Submitted:2006-08-28
Entered:2006-08-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0706R / 1 2 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / 0 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Fall, Fracture, Injury, Loss of consciousness, Syncope vasovagal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Vasovagal syncope shortly after receiving hep A and Gardasil vaccine, fell, hit nose on a drawer, loss of consciousness, sent to ER in transport broke nose.


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