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This is VAERS ID 263354

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

263354
VAERS Form:
Age:17.0
Gender:Female
Location:Massachusetts
Vaccinated:2006-09-06
Onset:2006-09-06
Submitted:2006-09-19
Entered:2006-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0800F / 0 UN / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Convulsion, Syncope

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: Hormonal contraceptions.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Information has been received from a nurse practitioner concerning a 17 year old female with no other pertinent medical history, adverse drug reactions or allergies reported. On 9/6/06, at 3:30pm, the pt was vaccianted IM with the first dose of 0.5ml of H"PV rL1 6 11 16 18 VLP vaccine yeast (lot 654540/0800F). Concomitant therapy included an unspecified hormonal contraceptives (also reported as birth control). On 9/6/06, the pt developed a mild seizure right after receiving HPV rL1 6 11 16 18 VLP vaccine y


Changed on 12/8/2009

263354 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Massachusetts
Vaccinated:2006-09-06
Onset:2006-09-06
Submitted:2006-09-19
Entered:2006-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. 0800F / 0 UN / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Convulsion, Syncope

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: Hormonal contraceptions.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) WAES0609USA02500

Write-up:Information has been received from a nurse practitioner concerning a 17 year old female with no other pertinent medical history, adverse drug reactions or allergies reported. On 9/6/06, at 3:30pm, the pt was vaccianted IM with the first dose of 0.5ml of H"PV HPV rL1 6 11 16 18 VLP vaccine yeast (lot 654540/0800F). Concomitant therapy included an unspecified hormonal contraceptives (also reported as birth control). On 9/6/06, the pt developed a mild seizure right after receiving HPV rL1 6 11 16 18 VLP vaccine y yeast. The pt came to and immediately fainted again. The pt sought unspecified medical attention. It was reported that the pt had not eaten anything all day. After eating, the pt felt better. On 9/6/06, the pt had fully recovered from the events. Upon internal review, the mild seizure was considered to be an other important medical event. Additional information has been requested.


Changed on 9/14/2017

263354 Before After
VAERS Form:(blank) 1
Age:17.0
Gender:Female
Location:Massachusetts
Vaccinated:2006-09-06
Onset:2006-09-06
Submitted:2006-09-19
Entered:2006-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0800F / 0 1 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Convulsion, Syncope

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: Hormonal contraceptions.
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES0609USA02500

Write-up:Information has been received from a nurse practitioner concerning a 17 year old female with no other pertinent medical history, adverse drug reactions or allergies reported. On 9/6/06, at 3:30pm, the pt was vaccianted IM with the first dose of 0.5ml of HPV rL1 6 11 16 18 VLP vaccine yeast (lot 654540/0800F). Concomitant therapy included an unspecified hormonal contraceptives (also reported as birth control). On 9/6/06, the pt developed a mild seizure right after receiving HPV rL1 6 11 16 18 VLP vaccine yeast. The pt came to and immediately fainted again. The pt sought unspecified medical attention. It was reported that the pt had not eaten anything all day. After eating, the pt felt better. On 9/6/06, the pt had fully recovered from the events. Upon internal review, the mild seizure was considered to be an other important medical event. Additional information has been requested.


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