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This is VAERS ID 263217

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 263217
Age:18.0
Gender:Female
Location:Massachusetts
Vaccinated:2006-08-18
Onset:2006-08-18
Submitted:2006-09-14
Entered:2006-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0702F / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Injection site pain, Syncope

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up:Information has been received from a nurse concerning an 18 year old female with no known allergies and no other pertinent medical history reported. On 18-AUG-2006, the patient was vaccinated intramuscularly in the deltoid with a 0.5 ml /"single dose pre"filled syringe/" of HPV rLi 6 11 16 18 VLP vaccine (yeast) (Lot#653650/0702F). There were no concomitant medication reported. On 18-AUG-2006, the patient developed severe injection site pain with HPV rLi 6 11 16 18 VLP vaccine (yeast) injection. The pa


Changed on 12/8/2009

VAERS ID: 263217 Before After
Age:18.0
Gender:Female
Location:Massachusetts
Vaccinated:2006-08-18
Onset:2006-08-18
Submitted:2006-09-14
Entered:2006-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. 0702F / - - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Injection site pain, Syncope

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC 'Split Type': (blank) WAES0608USA04485

Write-up:Information has been received from a nurse concerning an 18 year old female with no known allergies and no other pertinent medical history reported. On 18-AUG-2006, the patient was vaccinated intramuscularly in the deltoid with a 0.5 ml /"single "single dose pre"filled syringe/" prefilled syringe" of HPV rLi 6 11 16 18 VLP vaccine (yeast) (Lot#653650/0702F). There were no concomitant medication reported. On 18-AUG-2006, the patient developed severe injection site pain with HPV rLi 6 11 16 18 VLP vaccine (yeast) injection. The pa patient remarked that "it hurt and felt that the injection went to her head". The nurse reported that the patient felt faint immediately after the vaccination. The nurse had the patient lay down. It was reported that the patient "got up after 1 minute and said that she was ok.". The nurse reported that the "patient left the office immediately after this and the nurse was following up with the patient later today to make sure that the patient was ok." The nurse reported that she had not agitated the syringe prior to injection. The patient sought unspecified medical attention. There were no laboratory diagnostic studies performed. On 18-AUG-2006, the patient recovered from the events. Additional information has been requested.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=263217&WAYBACKHISTORY=ON


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