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This is VAERS ID 274301

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

274301
VAERS Form:
Age:20.0
Gender:Female
Location:Michigan
Vaccinated:2007-02-19
Onset:2007-02-19
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0013U / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Syncope

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

Write-up:Information has been received from a nurse concerning a 20 year old female who on 19-FEB-2007 was vaccinated IM with a dose of Gardasil (Lot # 654741/0013U). On 19-FEB-2007, the patient fainted after receiving the Gardasil injection. The patient was known"by the provider to be squeamish with injections. After the fainting episode, the patient was observed for a brief period of the time and then was discharged from the physician''''s office. On 19-FEB-2007, the patient recovered. No product quality complaint


Changed on 12/8/2009

274301 Before After
VAERS Form:
Age:20.0
Gender:Female
Location:Michigan
Vaccinated:2007-02-19
Onset:2007-02-19
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0013U / - - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': (blank) WAES0702USA03530

Write-up:Information has been received from a nurse concerning a 20 year old female who on 19-FEB-2007 was vaccinated IM with a dose of Gardasil (Lot # 654741/0013U). On 19-FEB-2007, the patient fainted after receiving the Gardasil injection. The patient was known"by known by the provider to be squeamish with injections. After the fainting episode, the patient was observed for a brief period of the time and then was discharged from the physician''''s physician''s office. On 19-FEB-2007, the patient recovered. No product quality complaint was involved. Additional information has been requested.


Changed on 9/14/2017

274301 Before After
VAERS Form:(blank) 1
Age:20.0
Gender:Female
Location:Michigan
Vaccinated:2007-02-19
Onset:2007-02-19
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0013U / - UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0702USA03530

Write-up:Information has been received from a nurse concerning a 20 year old female who on 19-FEB-2007 was vaccinated IM with a dose of Gardasil (Lot # 654741/0013U). On 19-FEB-2007, the patient fainted after receiving the Gardasil injection. The patient was known by the provider to be squeamish with injections. After the fainting episode, the patient was observed for a brief period of the time and then was discharged from the physician''s office. On 19-FEB-2007, the patient recovered. No product quality complaint was involved. Additional information has been requested.


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