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This is VAERS ID 277187

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

277187
VAERS Form:
Age:16.0
Gender:Female
Location:Texas
Vaccinated:2007-03-28
Onset:2007-03-28
Submitted:2007-04-04
Entered:2007-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1424F / 0 - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Deafness, Fall, Head injury, Syncope, Visual disturbance

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: NONE
Current Illness: Ingrown toenail
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Patient was administered the HPV (Gardasil) #1 vaccine at 12:30 pm. Patient was sitting when the vaccine was administered, she got up from the exam table, standing besides the table. Patient fainted, falling on the floor, hitting her head to left side, pt". said she stopped hearing and saw everything white. She was helped from the floor and placed on exam table on a laying position. She was resting for 1 hour. Pt after 1 hour felt better and left the office walking.


Changed on 12/8/2009

277187 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Texas
Vaccinated:2007-03-28
Onset:2007-03-28
Submitted:2007-04-04
Entered:2007-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1424F / 0 - / IM

Administered by: Private      Purchased by: Unknown Public
Symptoms: Deafness, Fall, Head injury, Syncope, Visual disturbance

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: NONE
Current Illness: Ingrown toenail
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) TX07026

Write-up:Patient was administered the HPV (Gardasil) #1 vaccine at 12:30 pm. Patient was sitting when the vaccine was administered, she got up from the exam table, standing besides the table. Patient fainted, falling on the floor, hitting her head to left side, pt". pt. said she stopped hearing and saw everything white. She was helped from the floor and placed on exam table on a laying position. She was resting for 1 hour. Pt after 1 hour felt better and left the office walking.


Changed on 9/14/2017

277187 Before After
VAERS Form:(blank) 1
Age:16.0
Gender:Female
Location:Texas
Vaccinated:2007-03-28
Onset:2007-03-28
Submitted:2007-04-04
Entered:2007-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1424F / 0 1 - / IM

Administered by: Private      Purchased by: Public
Symptoms: Deafness, Fall, Head injury, Syncope, Visual disturbance

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: NONE
Current Illness: Ingrown toenail
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': TX07026

Write-up:Patient was administered the HPV (Gardasil) #1 vaccine at 12:30 pm. Patient was sitting when the vaccine was administered, she got up from the exam table, standing besides the table. Patient fainted, falling on the floor, hitting her head to left side, pt. said she stopped hearing and saw everything white. She was helped from the floor and placed on exam table on a laying position. She was resting for 1 hour. Pt after 1 hour felt better and left the office walking.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=277187&WAYBACKHISTORY=ON


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