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This is VAERS ID 276947

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

276947
VAERS Form:
Age:15.0
Gender:Female
Location:California
Vaccinated:2007-03-01
Onset:2007-03-01
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: Unknown
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: Unk
Current Illness:
Preexisting Conditions: Unk
Allergies:
Diagnostic Lab Data: Unk
CDC 'Split Type':

Write-up:Information has been received from a physician concerning a 15 year old female who in approximately March 2007 was vaccinated, intramuscularly, into the deltoid, with a first dose of Gardasil concomitantly with a dose of Menactra. In approximately March 2"007 the patient fainted. Subsequently, the patient recovered. Additional information has been requested.


Changed on 12/8/2009

276947 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:California
Vaccinated:2007-03-01
Onset:2007-03-01
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: Unknown 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: Unk
Current Illness:
Preexisting Conditions: Unk
Allergies:
Diagnostic Lab Data: Unk
CDC 'Split Type': (blank) WAES0704USA00321

Write-up:Information has been received from a physician concerning a 15 year old female who in approximately March 2007 was vaccinated, intramuscularly, into the deltoid, with a first dose of Gardasil concomitantly with a dose of Menactra. In approximately March 2"007 2007 the patient fainted. Subsequently, the patient recovered. Additional information has been requested.


Changed on 9/14/2017

276947 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:California
Vaccinated:2007-03-01
Onset:2007-03-01
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: Unk
Current Illness:
Preexisting Conditions: Unk
Allergies:
Diagnostic Lab Data: Unk
CDC 'Split Type': WAES0704USA00321

Write-up:Information has been received from a physician concerning a 15 year old female who in approximately March 2007 was vaccinated, intramuscularly, into the deltoid, with a first dose of Gardasil concomitantly with a dose of Menactra. In approximately March 2007 the patient fainted. Subsequently, the patient recovered. Additional information has been requested.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=276947&WAYBACKHISTORY=ON


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