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This is VAERS ID 275915

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

275915
VAERS Form:
Age:19.0
Gender:Female
Location:Indiana
Vaccinated:2007-04-02
Onset:2007-04-02
Submitted:2007-04-03
Entered:2007-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0014U / 2 LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Loss of consciousness, Skin laceration

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: None
Current Illness: None
Preexisting Conditions: Allergic to Ceclor
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Student received Gardasil at 1500 on 4/2/07 - tolerated vaccine well - returned to dorm - subsequently passed out in dorm bathroom causing laceration to head.


Changed on 12/8/2009

275915 Before After
VAERS Form:
Age:19.0
Gender:Female
Location:Indiana
Vaccinated:2007-04-02
Onset:2007-04-02
Submitted:2007-04-03
Entered:2007-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0014U / 2 LA / IM

Administered by: Other      Purchased by: Unknown Private
Symptoms: Loss of consciousness, Skin laceration

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: None
Current Illness: None
Preexisting Conditions: Allergic to Ceclor
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Student received Gardasil at 1500 on 4/2/07 - tolerated vaccine well - returned to dorm - subsequently passed out in dorm bathroom causing laceration to head.


Changed on 9/14/2017

275915 Before After
VAERS Form:(blank) 1
Age:19.0
Gender:Female
Location:Indiana
Vaccinated:2007-04-02
Onset:2007-04-02
Submitted:2007-04-03
Entered:2007-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0014U / 2 3 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Loss of consciousness, Skin laceration

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: None
Current Illness: None
Preexisting Conditions: Allergic to Ceclor
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Student received Gardasil at 1500 on 4/2/07 - tolerated vaccine well - returned to dorm - subsequently passed out in dorm bathroom causing laceration to head.


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