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This is VAERS ID 276144

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

276144
VAERS Form:
Age:19.0
Gender:Female
Location:Unknown
Vaccinated:2007-03-05
Onset:2007-03-05
Submitted:2007-04-06
Entered:2007-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 653937/0637F / 1 - / IN

Administered by: Other      Purchased by: Unknown
Symptoms: Syncope

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

Write-up:Information has been received from a pharmacist concerning a 19 year old female with pertinent medical history and drug reactions/allergies reported as none who on 05, Mar 2007 was vaccinated with the second dose of HPV rL1 6 11 16 18 VLP vaccine (yeast),"( lot # 653937/0637F). Concomitant medication was reported as none. On 05, Mar 2007, 5 to 10 minutes after receiving the vaccination, the patient fainted. The patient sought unspecified medical attention. The outcome and causality of the event was not rep


Changed on 12/8/2009

276144 Before After
VAERS Form:
Age:19.0
Gender:Female
Location:Unknown
Vaccinated:2007-03-05
Onset:2007-03-05
Submitted:2007-04-06
Entered:2007-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 653937/0637F / 1 - / IN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) WAES0703USA00698

Write-up:Information has been received from a pharmacist concerning a 19 year old female with pertinent medical history and drug reactions/allergies reported as none who on 05, Mar 2007 was vaccinated with the second dose of HPV rL1 6 11 16 18 VLP vaccine (yeast),"( (yeast), ( lot # 653937/0637F). Concomitant medication was reported as none. On 05, Mar 2007, 5 to 10 minutes after receiving the vaccination, the patient fainted. The patient sought unspecified medical attention. The outcome and causality of the event was not rep reported. Additional information has been requested.


Changed on 9/14/2017

276144 Before After
VAERS Form:(blank) 1
Age:19.0
Gender:Female
Location:Unknown
Vaccinated:2007-03-05
Onset:2007-03-05
Submitted:2007-04-06
Entered:2007-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 653937/0637F / 1 2 - NS / IN

Administered by: Other      Purchased by: Other
Symptoms: Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES0703USA00698

Write-up:Information has been received from a pharmacist concerning a 19 year old female with pertinent medical history and drug reactions/allergies reported as none who on 05, Mar 2007 was vaccinated with the second dose of HPV rL1 6 11 16 18 VLP vaccine (yeast), ( lot # 653937/0637F). Concomitant medication was reported as none. On 05, Mar 2007, 5 to 10 minutes after receiving the vaccination, the patient fainted. The patient sought unspecified medical attention. The outcome and causality of the event was not reported. Additional information has been requested.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=276144&WAYBACKHISTORY=ON


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