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This is VAERS ID 276948

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

276948
VAERS Form:
Age:15.0
Gender:Female
Location:California
Vaccinated:0000-00-00
Onset:0000-00-00
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? 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
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: unknown
CDC 'Split Type':

Write-up:Information has been received from a physician concerning a 15 year old female who was vaccinated, intramuscularly, into the deltoid, with a first dose of Gardasil. Subsequently the patient fainted. Subsequently, the patient recovered. Additional informat"ion has been requested.


Changed on 12/8/2009

276948 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:California
Vaccinated:0000-00-00
Onset:0000-00-00
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? 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
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: unknown
CDC 'Split Type': (blank) WAES0704USA322

Write-up:Information has been received from a physician concerning a 15 year old female who was vaccinated, intramuscularly, into the deltoid, with a first dose of Gardasil. Subsequently the patient fainted. Subsequently, the patient recovered. Additional informat"ion information has been requested.


Changed on 9/14/2017

276948 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:California
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-04-13
Entered:2007-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 1 - / 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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: unknown
CDC 'Split Type': WAES0704USA322

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


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