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This is VAERS ID 262872

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

262872
VAERS Form:
Age:11.0
Gender:Female
Location:Florida
Vaccinated:2006-09-02
Onset:2006-09-02
Submitted:2006-09-02
Entered:2006-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 08007 / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Syncope, Tonic clonic movements

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

Write-up:Immediately after vaccine administration patient had syncopal episode with tonic posturing fell from table. Responded with gentle stimulation versus normal 5 minutes post regaining full consciousness.


Changed on 12/8/2009

262872 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:Florida
Vaccinated:2006-09-02
Onset:2006-09-02
Submitted:2006-09-02
Entered:2006-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. 08007 / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Syncope, Tonic clonic movements

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

Write-up:Immediately after vaccine administration patient had syncopal episode with tonic posturing fell from table. Responded with gentle stimulation versus normal 5 minutes post regaining full consciousness.


Changed on 9/14/2017

262872 Before After
VAERS Form:(blank) 1
Age:11.0
Gender:Female
Location:Florida
Vaccinated:2006-09-02
Onset:2006-09-02
Submitted:2006-09-02
Entered:2006-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 08007 / 0 1 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Syncope, Tonic clonic movements

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

Write-up:Immediately after vaccine administration patient had syncopal episode with tonic posturing fell from table. Responded with gentle stimulation versus normal 5 minutes post regaining full consciousness.


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