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This is VAERS ID 276064

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

276064
VAERS Form:
Age:15.0
Gender:Female
Location:Rhode Island
Vaccinated:2007-03-22
Onset:2007-03-22
Submitted:2007-04-11
Entered:2007-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / 0 - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Hypotension, 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: Ceclor allergy (rash)
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up:Passed out in hallway after receiving vaccine. BP 90/30 then elevated to 98/60 took 15 mins to he able to sit up BP normal taken prior to exam 94/60 P 84


Changed on 12/8/2009

276064 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Rhode Island
Vaccinated:2007-03-22
Onset:2007-03-22
Submitted:2007-04-11
Entered:2007-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / 0 - / IM

Administered by: Private      Purchased by: Unknown Public
Symptoms: Hypotension, 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: Ceclor allergy (rash)
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up:Passed out in hallway after receiving vaccine. BP 90/30 then elevated to 98/60 took 15 mins to he able to sit up BP normal taken prior to exam 94/60 P 84


Changed on 9/14/2017

276064 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:Rhode Island
Vaccinated:2007-03-22
Onset:2007-03-22
Submitted:2007-04-11
Entered:2007-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / 0 1 - / IM

Administered by: Private      Purchased by: Public
Symptoms: Hypotension, 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: Ceclor allergy (rash)
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up:Passed out in hallway after receiving vaccine. BP 90/30 then elevated to 98/60 took 15 mins to he able to sit up BP normal taken prior to exam 94/60 P 84


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