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This is VAERS ID 267030

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

267030
VAERS Form:
Age:17.0
Gender:Female
Location:Pennsylvania
Vaccinated:2006-11-15
Onset:2006-11-15
Submitted:2006-11-16
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0954F / 0 RA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Disorientation, Dyskinesia, Pallor, Syncope, Eye movement disorder

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: Adderall XL 30mg q day Depo Provera 150mg q 3 months
Current Illness: none
Preexisting Conditions: NKA none
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up:Within a minute of giving injection in rt deltoid, pt experienced pallor, syncope, rolling back of the eyes followed by jerky movements of upper & lower extremities. After 5 seconds, she became responsive, but disoriented to place. Pt stated that she had"not eaten much all day.


Changed on 12/8/2009

267030 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Pennsylvania
Vaccinated:2006-11-15
Onset:2006-11-15
Submitted:2006-11-16
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. 0954F / 0 RA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Disorientation, Dyskinesia, Pallor, Syncope, Eye movement disorder

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: Adderall XL 30mg q day Depo Provera 150mg q 3 months
Current Illness: none
Preexisting Conditions: NKA none
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up:Within a minute of giving injection in rt deltoid, pt experienced pallor, syncope, rolling back of the eyes followed by jerky movements of upper & lower extremities. After 5 seconds, she became responsive, but disoriented to place. Pt stated that she had"not had not eaten much all day.


Changed on 9/14/2017

267030 Before After
VAERS Form:(blank) 1
Age:17.0
Gender:Female
Location:Pennsylvania
Vaccinated:2006-11-15
Onset:2006-11-15
Submitted:2006-11-16
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0954F / 0 1 RA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Disorientation, Dyskinesia, Pallor, Syncope, Eye movement disorder

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: Adderall XL 30mg q day Depo Provera 150mg q 3 months
Current Illness: none
Preexisting Conditions: NKA none
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up:Within a minute of giving injection in rt deltoid, pt experienced pallor, syncope, rolling back of the eyes followed by jerky movements of upper & lower extremities. After 5 seconds, she became responsive, but disoriented to place. Pt stated that she had not eaten much all day.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=267030&WAYBACKHISTORY=ON


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