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This is VAERS ID 264743

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

264743
VAERS Form:
Age:21.0
Gender:Female
Location:Pennsylvania
Vaccinated:2006-09-11
Onset:2006-09-12
Submitted:2006-10-31
Entered:2006-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0702F / 0 UN / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Dizziness, Feeling abnormal, Headache, Malaise, Mydriasis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Zithromax, Wellbutrin, Klonopin, Lexapro, Nicomide, Minocycline.
Current Illness:
Preexisting Conditions: Syncope, Anxiety.
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up:Information has been received from a registered nurse concerning a 21 year old female with syncope, anxiety and no known allergies reported. On 9/11/06, the pt was vaccinated IM with the first dose of HPV rL1 6 11 16 18 VLP vaccine yeast (lot 653650/0702F"). Concomitant therapy included Lexapro, Wellbutrin, Klonopin, Nicomide, and Zithromax. On 9/12/06 when the pt woke up, she complained of her pupils being dilated, a headache, light headed and reported that she feels like something in not quite right. It


Changed on 12/8/2009

264743 Before After
VAERS Form:
Age:21.0
Gender:Female
Location:Pennsylvania
Vaccinated:2006-09-11
Onset:2006-09-12
Submitted:2006-10-31
Entered:2006-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. 0702F / 0 UN / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Dizziness, Feeling abnormal, Headache, Malaise, Mydriasis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Zithromax, Wellbutrin, Klonopin, Lexapro, Nicomide, Minocycline.
Current Illness:
Preexisting Conditions: Syncope, Anxiety.
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': (blank) WAES0609USA02502

Write-up:Information has been received from a registered nurse concerning a 21 year old female with syncope, anxiety and no known allergies reported. On 9/11/06, the pt was vaccinated IM with the first dose of HPV rL1 6 11 16 18 VLP vaccine yeast (lot 653650/0702F"). 653650/0702F). Concomitant therapy included Lexapro, Wellbutrin, Klonopin, Nicomide, and Zithromax. On 9/12/06 when the pt woke up, she complained of her pupils being dilated, a headache, light headed and reported that she feels like something in not quite right. It was reported that it was unknown if the pt had eaten that day. The pt sought unspecified medical attention. At the time of this report, the pt had not recovered from the events. Additional information has been requested.


Changed on 9/14/2017

264743 Before After
VAERS Form:(blank) 1
Age:21.0
Gender:Female
Location:Pennsylvania
Vaccinated:2006-09-11
Onset:2006-09-12
Submitted:2006-10-31
Entered:2006-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0702F / 0 1 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Dizziness, Feeling abnormal, Headache, Malaise, Mydriasis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Zithromax, Wellbutrin, Klonopin, Lexapro, Nicomide, Minocycline.
Current Illness:
Preexisting Conditions: Syncope, Anxiety.
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0609USA02502

Write-up:Information has been received from a registered nurse concerning a 21 year old female with syncope, anxiety and no known allergies reported. On 9/11/06, the pt was vaccinated IM with the first dose of HPV rL1 6 11 16 18 VLP vaccine yeast (lot 653650/0702F). Concomitant therapy included Lexapro, Wellbutrin, Klonopin, Nicomide, and Zithromax. On 9/12/06 when the pt woke up, she complained of her pupils being dilated, a headache, light headed and reported that she feels like something in not quite right. It was reported that it was unknown if the pt had eaten that day. The pt sought unspecified medical attention. At the time of this report, the pt had not recovered from the events. Additional information has been requested.


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