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This is VAERS ID 267490

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

267490
VAERS Form:
Age:
Gender:Female
Location:Virginia
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. - / - UN / -

Administered by: Other      Purchased by: Unknown
Symptoms: Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up:Information has been received from a registered nurse concerning a female pt who on an unspecified date was vaccinated with HPV vaccine. Subsequently, following the vaccination, the pt fainted. At the time of this report, the outcome of the event was unk."Additional information has been requested.


Changed on 12/8/2009

267490 Before After
VAERS Form:
Age:
Gender:Female
Location:Virginia
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. - / - UN / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': (blank) WAES0611USA02471

Write-up:Information has been received from a registered nurse concerning a female pt who on an unspecified date was vaccinated with HPV vaccine. Subsequently, following the vaccination, the pt fainted. At the time of this report, the outcome of the event was unk."Additional unk. Additional information has been requested.


Changed on 12/13/2013

267490 Before After
VAERS Form:
Age:
Gender:Female
Location:Virginia
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / - UN

Administered by: Other      Purchased by: Other
Symptoms: Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0611USA02471

Write-up:Information has been received from a registered nurse concerning a female pt who on an unspecified date was vaccinated with HPV vaccine. Subsequently, following the vaccination, the pt fainted. At the time of this report, the outcome of the event was unk. Additional information has been requested.


Changed on 6/14/2014

267490 Before After
VAERS Form:
Age:
Gender:Female
Location:Virginia
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0611USA02471

Write-up:Information has been received from a registered nurse concerning a female pt who on an unspecified date was vaccinated with HPV vaccine. Subsequently, following the vaccination, the pt fainted. At the time of this report, the outcome of the event was unk. Additional information has been requested.


Changed on 3/14/2015

267490 Before After
VAERS Form:
Age:
Gender:Female
Location:Virginia
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0611USA02471

Write-up:Information has been received from a registered nurse concerning a female pt who on an unspecified date was vaccinated with HPV vaccine. Subsequently, following the vaccination, the pt fainted. At the time of this report, the outcome of the event was unk. Additional information has been requested.


Changed on 9/14/2017

267490 Before After
VAERS Form:(blank) 1
Age:
Gender:Female
Location:Virginia
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0611USA02471

Write-up:Information has been received from a registered nurse concerning a female pt who on an unspecified date was vaccinated with HPV vaccine. Subsequently, following the vaccination, the pt fainted. At the time of this report, the outcome of the event was unk. Additional information has been requested.


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