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This is VAERS ID 269187

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 269187
Age:15.0
Gender:Female
Location:Arizona
Vaccinated:2006-09-12
Onset:2006-09-12
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0800F / 0 - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Loss of consciousness

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: DESOGEN
Current Illness:
Preexisting Conditions: CONCURRENT CONDITIONS: Polycystic ovarian syndrome
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Information has been received from a physician concerning an 15 year old female with a history of polycystic ovary syndrome, who on 12-Sep-2006 was vaccinated intramuscularly with the first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast) (Lot#654540/0800F)". Subsequently, shortly after receiving the vaccination the patient fainted. Subsequently, the patient recovered from the syncope. Unspecified medical attention was sought. Additional information has been requested.


Changed on 12/8/2009

VAERS ID: 269187 Before After
Age:15.0
Gender:Female
Location:Arizona
Vaccinated:2006-09-12
Onset:2006-09-12
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. 0800F / 0 - / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Loss of consciousness

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: DESOGEN
Current Illness:
Preexisting Conditions: CONCURRENT CONDITIONS: Polycystic ovarian syndrome
Diagnostic Lab Data:
CDC 'Split Type': (blank) WAES0611USA03478

Write-up:Information has been received from a physician concerning an 15 year old female with a history of polycystic ovary syndrome, who on 12-Sep-2006 was vaccinated intramuscularly with the first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast) (Lot#654540/0800F)". (Lot#654540/0800F). Subsequently, shortly after receiving the vaccination the patient fainted. Subsequently, the patient recovered from the syncope. Unspecified medical attention was sought. Additional information has been requested.


Changed on 5/14/2017

VAERS ID: 269187 Before After
Age:15.0
Gender:Female
Location:Arizona
Vaccinated:2006-09-12
Onset:2006-09-12
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0800F / 0 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Loss of consciousness, Syncope

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: DESOGEN
Current Illness:
Preexisting Conditions: CONCURRENT CONDITIONS: Polycystic ovarian syndrome
Diagnostic Lab Data:
CDC 'Split Type': WAES0611USA03478

Write-up:Information has been received from a physician concerning an 15 year old female with a history of polycystic ovary syndrome, who on 12-Sep-2006 was vaccinated intramuscularly with the first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast) (Lot#654540/0800F). Subsequently, shortly after receiving the vaccination the patient fainted. Subsequently, the patient recovered from the syncope. Unspecified medical attention was sought. Additional information has been requested.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=269187&WAYBACKHISTORY=ON


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