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This is VAERS ID 276042

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

276042
VAERS Form:
Age:22.0
Gender:Female
Location:Florida
Vaccinated:2007-04-11
Onset:2007-04-11
Submitted:2007-04-11
Entered:2007-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0012U / 0 LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Anxiety, Computerised tomogram normal, Concussion, Confusional state, Crying

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 KNOWN
Current Illness: NONE KNOWN
Preexisting Conditions: NONE KNOWN
Allergies:
Diagnostic Lab Data: TRANSFERRED BY AMBULANCE TO MORTON PLANT HOSPPER MOTHERS REPORT: CLIENT GIVEN IV FLUIDS AND CT SCAN. MOTHER REPORTS CT SCAN NORMAL BUT DID NOT R/O OR CONFIRM CONCUSSION CLIENT RELEASED FROM HOSPITAL AROUND NOON. MOTHER REPORTS ED RECOMMEN
CDC 'Split Type':

Write-up:APPROXIMATELY 10 MINUTES AFTER VACCINE ADMINISTRATION CLIENT PASSED OUT FALLING AND HITTING HER HEAD. CLIENT AROUSED IN A FEW SECONDS. VITAL SIGNS CHECKED. APPROXIMATELY 20 MINUTES LATER CLIENT REPORTED FEELING ANXIOUS AND CONFUSED, CRYING, AMBULANCE C"ALLED


Changed on 12/8/2009

276042 Before After
VAERS Form:
Age:22.0
Gender:Female
Location:Florida
Vaccinated:2007-04-11
Onset:2007-04-11
Submitted:2007-04-11
Entered:2007-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0012U / 0 LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Anxiety, Computerised tomogram normal, Concussion, Confusional state, Crying, Fall, Head injury, Loss of consciousness

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 KNOWN
Current Illness: NONE KNOWN
Preexisting Conditions: NONE KNOWN
Allergies:
Diagnostic Lab Data: TRANSFERRED BY AMBULANCE TO MORTON PLANT HOSPPER MOTHERS REPORT: CLIENT GIVEN IV FLUIDS AND CT SCAN. MOTHER REPORTS CT SCAN NORMAL BUT DID NOT R/O OR CONFIRM CONCUSSION CLIENT RELEASED FROM HOSPITAL AROUND NOON. MOTHER REPORTS ED RECOMMEN
CDC 'Split Type':

Write-up:APPROXIMATELY 10 MINUTES AFTER VACCINE ADMINISTRATION CLIENT PASSED OUT FALLING AND HITTING HER HEAD. CLIENT AROUSED IN A FEW SECONDS. VITAL SIGNS CHECKED. APPROXIMATELY 20 MINUTES LATER CLIENT REPORTED FEELING ANXIOUS AND CONFUSED, CRYING, AMBULANCE C"ALLED CALLED


Changed on 2/13/2013

276042 Before After
VAERS Form:
Age:22.0 19.0
Gender:Female
Location:Florida
Vaccinated:2007-04-11
Onset:2007-04-11
Submitted:2007-04-11
Entered:2007-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0012U / 0 LA / IM

Administered by: Public Unknown      Purchased by: Unknown
Symptoms: Anxiety, Computerised tomogram normal, Concussion, Confusional state, Crying, Fall, Head injury, Loss of consciousness

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 KNOWN
Current Illness: NONE KNOWN
Preexisting Conditions: NONE KNOWN
Allergies:
Diagnostic Lab Data: TRANSFERRED BY AMBULANCE TO MORTON PLANT HOSPPER HOSP PER MOTHERS REPORT: CLIENT GIVEN IV FLUIDS AND CT SCAN. MOTHER REPORTS CT SCAN NORMAL BUT DID NOT R/O OR CONFIRM CONCUSSION CLIENT RELEASED FROM HOSPITAL AROUND NOON. MOTHER REPORTS ED RECOMMEN RECOMMENDED F/U CT SCAN IN 3 MONTHS.
CDC 'Split Type':

Write-up:APPROXIMATELY 10 MINUTES AFTER VACCINE ADMINISTRATION CLIENT PASSED OUT FALLING AND HITTING HER HEAD. CLIENT AROUSED IN A FEW SECONDS. VITAL SIGNS CHECKED. APPROXIMATELY 20 MINUTES LATER CLIENT REPORTED FEELING ANXIOUS AND CONFUSED, CRYING, AMBULANCE CALLED


Changed on 6/14/2014

276042 Before After
VAERS Form:
Age:19.0
Gender:Female
Location:Florida
Vaccinated:2007-04-11
Onset:2007-04-11
Submitted:2007-04-11
Entered:2007-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0012U / 0 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anxiety, Computerised tomogram normal, Concussion, Confusional state, Crying, Fall, Head injury, Loss of consciousness

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 KNOWN
Current Illness: NONE KNOWN
Preexisting Conditions: NONE KNOWN
Allergies:
Diagnostic Lab Data: TRANSFERRED BY AMBULANCE TO HOSP PER MOTHERS REPORT: CLIENT GIVEN IV FLUIDS AND CT SCAN. MOTHER REPORTS CT SCAN NORMAL BUT DID NOT R/O OR CONFIRM CONCUSSION CLIENT RELEASED FROM HOSPITAL AROUND NOON. MOTHER REPORTS ED RECOMMENDED F/U CT SCAN IN 3 MONTHS.
CDC 'Split Type':

Write-up:APPROXIMATELY 10 MINUTES AFTER VACCINE ADMINISTRATION CLIENT PASSED OUT FALLING AND HITTING HER HEAD. CLIENT AROUSED IN A FEW SECONDS. VITAL SIGNS CHECKED. APPROXIMATELY 20 MINUTES LATER CLIENT REPORTED FEELING ANXIOUS AND CONFUSED, CRYING, AMBULANCE CALLED


Changed on 3/14/2015

276042 Before After
VAERS Form:
Age:19.0
Gender:Female
Location:Florida
Vaccinated:2007-04-11
Onset:2007-04-11
Submitted:2007-04-11
Entered:2007-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0012U / 0 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anxiety, Computerised tomogram normal, Concussion, Confusional state, Crying, Fall, Head injury, Loss of consciousness

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 KNOWN
Current Illness: NONE KNOWN
Preexisting Conditions: NONE KNOWN
Allergies:
Diagnostic Lab Data: TRANSFERRED BY AMBULANCE TO HOSP PER MOTHERS REPORT: CLIENT GIVEN IV FLUIDS AND CT SCAN. MOTHER REPORTS CT SCAN NORMAL BUT DID NOT R/O OR CONFIRM CONCUSSION CLIENT RELEASED FROM HOSPITAL AROUND NOON. MOTHER REPORTS ED RECOMMENDED F/U CT SCAN IN 3 MONTHS.
CDC 'Split Type':

Write-up:APPROXIMATELY 10 MINUTES AFTER VACCINE ADMINISTRATION CLIENT PASSED OUT FALLING AND HITTING HER HEAD. CLIENT AROUSED IN A FEW SECONDS. VITAL SIGNS CHECKED. APPROXIMATELY 20 MINUTES LATER CLIENT REPORTED FEELING ANXIOUS AND CONFUSED, CRYING, AMBULANCE CALLED


Changed on 9/14/2017

276042 Before After
VAERS Form:(blank) 1
Age:19.0
Gender:Female
Location:Florida
Vaccinated:2007-04-11
Onset:2007-04-11
Submitted:2007-04-11
Entered:2007-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0012U / 0 1 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anxiety, Computerised tomogram normal, Concussion, Confusional state, Crying, Fall, Head injury, Loss of consciousness

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 KNOWN
Current Illness: NONE KNOWN
Preexisting Conditions: NONE KNOWN
Allergies:
Diagnostic Lab Data: TRANSFERRED BY AMBULANCE TO HOSP PER MOTHERS REPORT: CLIENT GIVEN IV FLUIDS AND CT SCAN. MOTHER REPORTS CT SCAN NORMAL BUT DID NOT R/O OR CONFIRM CONCUSSION CLIENT RELEASED FROM HOSPITAL AROUND NOON. MOTHER REPORTS ED RECOMMENDED F/U CT SCAN IN 3 MONTHS.
CDC 'Split Type':

Write-up:APPROXIMATELY 10 MINUTES AFTER VACCINE ADMINISTRATION CLIENT PASSED OUT FALLING AND HITTING HER HEAD. CLIENT AROUSED IN A FEW SECONDS. VITAL SIGNS CHECKED. APPROXIMATELY 20 MINUTES LATER CLIENT REPORTED FEELING ANXIOUS AND CONFUSED, CRYING, AMBULANCE CALLED


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