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This is VAERS ID 275509

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 275509
VAERS Form:
Age:13.0
Gender:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-04-02
Entered:2007-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / 0 - / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Electrocardiogram QT prolonged, Heart rate increased, Loss of consciousness

Life Threatening? Yes
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? Yes, days: 0     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: electrocardiogram - prolonged Q-T, total heartbeat count over
CDC 'Split Type':

Write-up: Information has been received from a nurse practitioner concerning a 13 year old female who on an unspecified date was vaccinated with first dose, single dose vial, of Gardasil (lot # not reported) IM injection. On an unspecified date, within 10 minutes o"f receiving the vaccination, the patient passed out. The patient''''s heart rate was over 200. The patient passed out a total of three times. Medical attention was sought. The patient was hospitalized as a result of the experience. At the time of reporting,


Changed on 12/8/2009

VAERS ID: 275509 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-04-02
Entered:2007-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / 0 - / IM

Administered by: Public      Purchased by: Unknown Other
Symptoms: Electrocardiogram QT prolonged, Heart rate increased, Loss of consciousness

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 0 (blank)     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: electrocardiogram - prolonged Q-T, total heartbeat count over
CDC 'Split Type': (blank) WAES0703USA04642

Write-up: Information has been received from a nurse practitioner concerning a 13 year old female who on an unspecified date was vaccinated with first dose, single dose vial, of Gardasil (lot # not reported) IM injection. On an unspecified date, within 10 minutes o"f of receiving the vaccination, the patient passed out. The patient''''s patient''s heart rate was over 200. The patient passed out a total of three times. Medical attention was sought. The patient was hospitalized as a result of the experience. At the time of reporting, the patient had prolonged Q-T and was being seen by a cardiologist for the condition. The outcome of the events was unknown. The reporter considered the events to be immediately life-threatening. Additional information has been requested.


Changed on 9/14/2017

VAERS ID: 275509 Before After
VAERS Form:(blank) 1
Age:13.0
Gender:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-04-02
Entered:2007-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / 0 1 - / IM

Administered by: Public      Purchased by: Other
Symptoms: Electrocardiogram QT prolonged, Heart rate increased, Loss of consciousness

Life Threatening? Yes
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? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: electrocardiogram - prolonged Q-T, total heartbeat count over
CDC 'Split Type': WAES0703USA04642

Write-up: Information has been received from a nurse practitioner concerning a 13 year old female who on an unspecified date was vaccinated with first dose, single dose vial, of Gardasil (lot # not reported) IM injection. On an unspecified date, within 10 minutes of receiving the vaccination, the patient passed out. The patient''s heart rate was over 200. The patient passed out a total of three times. Medical attention was sought. The patient was hospitalized as a result of the experience. At the time of reporting, the patient had prolonged Q-T and was being seen by a cardiologist for the condition. The outcome of the events was unknown. The reporter considered the events to be immediately life-threatening. Additional information has been requested.


Changed on 2/14/2018

VAERS ID: 275509 Before After
VAERS Form:1
Age:13.0
Gender:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-04-02
Entered:2007-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / 1 - / IM

Administered by: Public      Purchased by: Other
Symptoms: Electrocardiogram QT prolonged, Heart rate increased, Loss of consciousness

Life Threatening? Yes
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? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: electrocardiogram - prolonged Q-T, total heartbeat count over
CDC 'Split Type': WAES0703USA04642

Write-up: Information has been received from a nurse practitioner concerning a 13 year old female who on an unspecified date was vaccinated with first dose, single dose vial, of Gardasil (lot # not reported) IM injection. On an unspecified date, within 10 minutes of receiving the vaccination, the patient passed out. The patient''s heart rate was over 200. The patient passed out a total of three times. Medical attention was sought. The patient was hospitalized as a result of the experience. At the time of reporting, the patient had prolonged Q-T and was being seen by a cardiologist for the condition. The outcome of the events was unknown. The reporter considered the events to be immediately life-threatening. Additional information has been requested.


Changed on 6/14/2018

VAERS ID: 275509 Before After
VAERS Form:1
Age:13.0
Gender:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-04-02
Entered:2007-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / 1 - / IM

Administered by: Public      Purchased by: Other
Symptoms: Electrocardiogram QT prolonged, Heart rate increased, Loss of consciousness

Life Threatening? Yes
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? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: electrocardiogram - prolonged Q-T, total heartbeat count over
CDC 'Split Type': WAES0703USA04642

Write-up: Information has been received from a nurse practitioner concerning a 13 year old female who on an unspecified date was vaccinated with first dose, single dose vial, of Gardasil (lot # not reported) IM injection. On an unspecified date, within 10 minutes of receiving the vaccination, the patient passed out. The patient''s heart rate was over 200. The patient passed out a total of three times. Medical attention was sought. The patient was hospitalized as a result of the experience. At the time of reporting, the patient had prolonged Q-T and was being seen by a cardiologist for the condition. The outcome of the events was unknown. The reporter considered the events to be immediately life-threatening. Additional information has been requested.


Changed on 8/14/2018

VAERS ID: 275509 Before After
VAERS Form:1
Age:13.0
Gender:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-04-02
Entered:2007-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / 1 - / IM

Administered by: Public      Purchased by: Other
Symptoms: Electrocardiogram QT prolonged, Heart rate increased, Loss of consciousness

Life Threatening? Yes
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? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: electrocardiogram - prolonged Q-T, total heartbeat count over
CDC 'Split Type': WAES0703USA04642

Write-up: Information has been received from a nurse practitioner concerning a 13 year old female who on an unspecified date was vaccinated with first dose, single dose vial, of Gardasil (lot # not reported) IM injection. On an unspecified date, within 10 minutes of receiving the vaccination, the patient passed out. The patient''s heart rate was over 200. The patient passed out a total of three times. Medical attention was sought. The patient was hospitalized as a result of the experience. At the time of reporting, the patient had prolonged Q-T and was being seen by a cardiologist for the condition. The outcome of the events was unknown. The reporter considered the events to be immediately life-threatening. Additional information has been requested.


Changed on 9/14/2018

VAERS ID: 275509 Before After
VAERS Form:1
Age:13.0
Gender:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-04-02
Entered:2007-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / 1 - / IM

Administered by: Public      Purchased by: Other
Symptoms: Electrocardiogram QT prolonged, Heart rate increased, Loss of consciousness

Life Threatening? Yes
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? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: electrocardiogram - prolonged Q-T, total heartbeat count over
CDC 'Split Type': WAES0703USA04642

Write-up: Information has been received from a nurse practitioner concerning a 13 year old female who on an unspecified date was vaccinated with first dose, single dose vial, of Gardasil (lot # not reported) IM injection. On an unspecified date, within 10 minutes of receiving the vaccination, the patient passed out. The patient''s heart rate was over 200. The patient passed out a total of three times. Medical attention was sought. The patient was hospitalized as a result of the experience. At the time of reporting, the patient had prolonged Q-T and was being seen by a cardiologist for the condition. The outcome of the events was unknown. The reporter considered the events to be immediately life-threatening. Additional information has been requested.


Changed on 10/14/2018

VAERS ID: 275509 Before After
VAERS Form:1
Age:13.0
Gender:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-04-02
Entered:2007-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / 1 - / IM

Administered by: Public      Purchased by: Other
Symptoms: Electrocardiogram QT prolonged, Heart rate increased, Loss of consciousness

Life Threatening? Yes
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? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: electrocardiogram - prolonged Q-T, total heartbeat count over
CDC 'Split Type': WAES0703USA04642

Write-up: Information has been received from a nurse practitioner concerning a 13 year old female who on an unspecified date was vaccinated with first dose, single dose vial, of Gardasil (lot # not reported) IM injection. On an unspecified date, within 10 minutes of receiving the vaccination, the patient passed out. The patient''s heart rate was over 200. The patient passed out a total of three times. Medical attention was sought. The patient was hospitalized as a result of the experience. At the time of reporting, the patient had prolonged Q-T and was being seen by a cardiologist for the condition. The outcome of the events was unknown. The reporter considered the events to be immediately life-threatening. Additional information has been requested.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=275509&WAYBACKHISTORY=ON


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