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This is VAERS ID 276946

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

276946
VAERS Form:
Age:14.0
Gender:Female
Location:California
Vaccinated:2007-03-23
Onset:2007-03-23
Submitted:2007-04-13
Entered:2007-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 - / IM

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 physician concerning a 14 year old female who on approximately 23-MAR-2007, was vaccinated intramuscularly with a first dose of Gardasil vaccine (yeast). On approximately 23-MAR-2007 the patient fainted. The patient di"d not seek medical attention. Subsequently, the patient recovered. Additional information has been requested.


Changed on 12/8/2009

276946 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:California
Vaccinated:2007-03-23
Onset:2007-03-23
Submitted:2007-04-13
Entered:2007-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 - / IM

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) WAES0704USA00199

Write-up:Information has been received from a physician concerning a 14 year old female who on approximately 23-MAR-2007, was vaccinated intramuscularly with a first dose of Gardasil vaccine (yeast). On approximately 23-MAR-2007 the patient fainted. The patient di"d did not seek medical attention. Subsequently, the patient recovered. Additional information has been requested.


Changed on 1/5/2010

276946 Before After
VAERS Form:
Age:14.0 16.0
Gender:Female
Location:California
Vaccinated:2007-03-23
Onset:2007-03-23
Submitted:2007-04-13
Entered:2007-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 - UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No 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: Unknown ZYRTEC
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0704USA00199

Write-up:Information has been received from a physician concerning a 14 year old female who on approximately 23-MAR-2007, was vaccinated intramuscularly with a first dose of Gardasil vaccine (yeast). On approximately 23-MAR-2007 the patient fainted. The patient did not seek medical attention. Subsequently, the patient recovered. Additional information has been requested. This is in follow-up to report (s) previously submitted on 4/11/2007. Initial and follow-up information has been received from a physician concerning a 14 year old female who on 12-MAR-2007, at 16:30 was vaccinated intramuscular with a first dose of GARDASIL (lot #654510/0962F). Concomitant therapy included ZYRTEC. On 12-MAR-2007 the patient experienced syncope following vaccination. The patient was given water and trail mix. Te patient also experienced loss of consciousness for a few second. She fell inito a chair in the waiting room and developed a bruise on her left stapula. The patient was observed for 20 minutes. On 12-MAR-2007 the patient recovered. Additional information is not expected.


Changed on 6/14/2014

276946 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:California
Vaccinated:2007-03-23
Onset:2007-03-23
Submitted:2007-04-13
Entered:2007-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Syncope

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: ZYRTEC
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0704USA00199

Write-up:Information has been received from a physician concerning a 14 year old female who on approximately 23-MAR-2007, was vaccinated intramuscularly with a first dose of Gardasil vaccine (yeast). On approximately 23-MAR-2007 the patient fainted. The patient did not seek medical attention. Subsequently, the patient recovered. Additional information has been requested. This is in follow-up to report (s) previously submitted on 4/11/2007. Initial and follow-up information has been received from a physician concerning a 14 year old female who on 12-MAR-2007, at 16:30 was vaccinated intramuscular with a first dose of GARDASIL (lot #654510/0962F). Concomitant therapy included ZYRTEC. On 12-MAR-2007 the patient experienced syncope following vaccination. The patient was given water and trail mix. Te patient also experienced loss of consciousness for a few second. She fell inito a chair in the waiting room and developed a bruise on her left stapula. The patient was observed for 20 minutes. On 12-MAR-2007 the patient recovered. Additional information is not expected.


Changed on 5/14/2017

276946 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:California
Vaccinated:2007-03-23
Onset:2007-03-23
Submitted:2007-04-13
Entered:2007-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Syncope

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: ZYRTEC
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0704USA00199

Write-up:Information has been received from a physician concerning a 14 year old female who on approximately 23-MAR-2007, was vaccinated intramuscularly with a first dose of Gardasil vaccine (yeast). On approximately 23-MAR-2007 the patient fainted. The patient did not seek medical attention. Subsequently, the patient recovered. Additional information has been requested. This is in follow-up to report (s) previously submitted on 4/11/2007. Initial and follow-up information has been received from a physician concerning a 14 year old female who on 12-MAR-2007, at 16:30 was vaccinated intramuscular with a first dose of GARDASIL (lot #654510/0962F). Concomitant therapy included ZYRTEC. On 12-MAR-2007 the patient experienced syncope following vaccination. The patient was given water and trail mix. Te patient also experienced loss of consciousness for a few second. She fell inito a chair in the waiting room and developed a bruise on her left stapula. The patient was observed for 20 minutes. On 12-MAR-2007 the patient recovered. Additional information is not expected.


Changed on 9/14/2017

276946 Before After
VAERS Form:(blank) 1
Age:16.0
Gender:Female
Location:California
Vaccinated:2007-03-23
Onset:2007-03-23
Submitted:2007-04-13
Entered:2007-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 1 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Syncope

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: ZYRTEC
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0704USA00199

Write-up:Information has been received from a physician concerning a 14 year old female who on approximately 23-MAR-2007, was vaccinated intramuscularly with a first dose of Gardasil vaccine (yeast). On approximately 23-MAR-2007 the patient fainted. The patient did not seek medical attention. Subsequently, the patient recovered. Additional information has been requested. This is in follow-up to report (s) previously submitted on 4/11/2007. Initial and follow-up information has been received from a physician concerning a 14 year old female who on 12-MAR-2007, at 16:30 was vaccinated intramuscular with a first dose of GARDASIL (lot #654510/0962F). Concomitant therapy included ZYRTEC. On 12-MAR-2007 the patient experienced syncope following vaccination. The patient was given water and trail mix. Te patient also experienced loss of consciousness for a few second. She fell inito a chair in the waiting room and developed a bruise on her left stapula. The patient was observed for 20 minutes. On 12-MAR-2007 the patient recovered. Additional information is not expected.


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