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This is VAERS ID 272623

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 272623
VAERS Form:
Age:16.0
Gender:Female
Location:Maryland
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-02-14
Entered:2007-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Injection site pain, Loss of consciousness

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: Tetanus toxoid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up: Information has been received from a nurse practitioner concerning a 16 year old female who on an unspecified date was vaccinated intramuscularly with the first dose of Gardasil. Concomitant therapy included a tetanus toxoid shot. Immediately with vaccina"tion, the patient developed injection site stinging and the patient passed out for a few seconds. The patient sought unspecified medical attention. The nurse practitioner reported that the patient was fine after a few seconds and was able to drive home. T


Changed on 12/8/2009

VAERS ID: 272623 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Maryland
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-02-14
Entered:2007-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Injection site pain, Loss of consciousness

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: Tetanus toxoid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': (blank) WAES0702USA00207

Write-up: Information has been received from a nurse practitioner concerning a 16 year old female who on an unspecified date was vaccinated intramuscularly with the first dose of Gardasil. Concomitant therapy included a tetanus toxoid shot. Immediately with vaccina"tion, vaccination, the patient developed injection site stinging and the patient passed out for a few seconds. The patient sought unspecified medical attention. The nurse practitioner reported that the patient was fine after a few seconds and was able to drive home. T Thee was no lot number provided. Additional information has been requested.


Changed on 9/14/2017

VAERS ID: 272623 Before After
VAERS Form:(blank) 1
Age:16.0
Gender:Female
Location:Maryland
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-02-14
Entered:2007-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Injection site pain, Loss of consciousness

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: Tetanus toxoid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0702USA00207

Write-up: Information has been received from a nurse practitioner concerning a 16 year old female who on an unspecified date was vaccinated intramuscularly with the first dose of Gardasil. Concomitant therapy included a tetanus toxoid shot. Immediately with vaccination, the patient developed injection site stinging and the patient passed out for a few seconds. The patient sought unspecified medical attention. The nurse practitioner reported that the patient was fine after a few seconds and was able to drive home. Thee was no lot number provided. Additional information has been requested.


Changed on 2/14/2018

VAERS ID: 272623 Before After
VAERS Form:1
Age:16.0
Gender:Female
Location:Maryland
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-02-14
Entered:2007-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Injection site pain, Loss of consciousness

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: Tetanus toxoid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0702USA00207

Write-up: Information has been received from a nurse practitioner concerning a 16 year old female who on an unspecified date was vaccinated intramuscularly with the first dose of Gardasil. Concomitant therapy included a tetanus toxoid shot. Immediately with vaccination, the patient developed injection site stinging and the patient passed out for a few seconds. The patient sought unspecified medical attention. The nurse practitioner reported that the patient was fine after a few seconds and was able to drive home. Thee was no lot number provided. Additional information has been requested.


Changed on 6/14/2018

VAERS ID: 272623 Before After
VAERS Form:1
Age:16.0
Gender:Female
Location:Maryland
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-02-14
Entered:2007-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Injection site pain, Loss of consciousness

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: Tetanus toxoid
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0702USA00207

Write-up: Information has been received from a nurse practitioner concerning a 16 year old female who on an unspecified date was vaccinated intramuscularly with the first dose of Gardasil. Concomitant therapy included a tetanus toxoid shot. Immediately with vaccination, the patient developed injection site stinging and the patient passed out for a few seconds. The patient sought unspecified medical attention. The nurse practitioner reported that the patient was fine after a few seconds and was able to drive home. Thee was no lot number provided. Additional information has been requested.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=272623&WAYBACKHISTORY=ON


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