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This is VAERS ID 277319

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

277319
VAERS Form:
Age:12.0
Gender:Female
Location:New Mexico
Vaccinated:2007-04-13
Onset:2007-04-13
Submitted:2007-04-24
Entered:2007-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB148AA / 0 LA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0187U / - UN / -

Administered by: Private      Purchased by: Unknown
Symptoms: Dizziness, Loss of consciousness, 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)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: No concurrent medication
Current Illness: Unknown
Preexisting Conditions: The subject was reported to be ""otherwise healthy"". The subject experienced no adverse events following previous vaccinations.
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up:This case was reported by a physician and described the occurrence of unconscious in a 12-year-old female subject who was vaccinated with Havrix, Gardasil for prophylaxis. The subject was reported to be /"otherwise healthy/". The subject experienced on ad"verse events following previous vaccinations. There were no concurrent medications. On 13 April 2007 at 11:00, the subject received the 1st dose of Havrix (.5 ml, unknown, left arm). On 13 April 2007 at an unspecified time, the subject received the 1st do


Changed on 12/8/2009

277319 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:New Mexico
Vaccinated:2007-04-13
Onset:2007-04-13
Submitted:2007-04-24
Entered:2007-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB148AA / 0 LA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0187U / - UN / -

Administered by: Private      Purchased by: Unknown Other
Symptoms: Dizziness, Loss of consciousness, 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)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: No concurrent medication
Current Illness: Unknown
Preexisting Conditions: The subject was reported to be ""otherwise healthy"". "otherwise healthy". The subject experienced no adverse events following previous vaccinations.
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': (blank) A0647898A

Write-up:This case was reported by a physician and described the occurrence of unconscious in a 12-year-old female subject who was vaccinated with Havrix, Gardasil for prophylaxis. The subject was reported to be /"otherwise healthy/". "otherwise healthy". The subject experienced on ad"verse adverse events following previous vaccinations. There were no concurrent medications. On 13 April 2007 at 11:00, the subject received the 1st dose of Havrix (.5 ml, unknown, left arm). On 13 April 2007 at an unspecified time, the subject received the 1st do dose of Gardasil. On 13 April 2007, 2 minutes after vaccination with Havrix and an unspecified time after vaccination with Gardasil, the subject experienced two episodes of dizziness and fainting within five minutes of dosing. The subject was unconscious for a minute or less with each episode. This case was assessed as medically serious by manufacturer. On 13 April 2007, the events were resolved.


Changed on 1/5/2010

277319 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:New Mexico
Vaccinated:2007-04-13
Onset:2007-04-13
Submitted:2007-04-24
Entered:2007-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB148AA / 0 LA / - IJ
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0187U / - 0 UN / - IJ

Administered by: Private      Purchased by: Other
Symptoms: Dizziness, Loss of consciousness, 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)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: No concurrent medication
Current Illness: Unknown
Preexisting Conditions: The subject was reported to be "otherwise healthy". The subject experienced no adverse events following previous vaccinations.
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': A0647898A

Write-up:This case was reported by a physician and described the occurrence of unconscious in a 12-year-old female subject who was vaccinated with Havrix, Gardasil for prophylaxis. The subject was reported to be "otherwise healthy". The subject experienced on adverse events following previous vaccinations. There were no concurrent medications. On 13 April 2007 at 11:00, the subject received the 1st dose of Havrix (.5 ml, unknown, left arm). On 13 April 2007 at an unspecified time, the subject received the 1st dose of Gardasil. On 13 April 2007, 2 minutes after vaccination with Havrix and an unspecified time after vaccination with Gardasil, the subject experienced two episodes of dizziness and fainting within five minutes of dosing. The subject was unconscious for a minute or less with each episode. This case was assessed as medically serious by manufacturer. On 13 April 2007, the events were resolved.


Changed on 6/2/2010

277319 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:New Mexico
Vaccinated:2007-04-13
Onset:2007-04-13
Submitted:2007-04-24
Entered:2007-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB148AA / 0 LA / IJ
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0187U / 0 UN / IJ

Administered by: Private      Purchased by: Other
Symptoms: Dizziness, Loss of consciousness, 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)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: No concurrent medication
Current Illness: Unknown
Preexisting Conditions: The subject was reported to be "otherwise healthy". The subject experienced no adverse events following previous vaccinations.
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': A0647898A

Write-up:This case was reported by a physician and described the occurrence of unconscious in a 12-year-old female subject who was vaccinated with Havrix, Gardasil for prophylaxis. The subject was reported to be "otherwise healthy". The subject experienced on adverse events following previous vaccinations. There were no concurrent medications. On 13 April 2007 at 11:00, the subject received the 1st dose of Havrix (.5 ml, unknown, left arm). On 13 April 2007 at an unspecified time, the subject received the 1st dose of Gardasil. On 13 April 2007, 2 minutes after vaccination with Havrix and an unspecified time after vaccination with Gardasil, the subject experienced two episodes of dizziness and fainting within five minutes of dosing. The subject was unconscious for a minute or less with each episode. This case was assessed as medically serious by manufacturer. On 13 April 2007, the events were resolved. 06/17/10 Follow-up information was identified from a line listing obtained on request by the Company from the FDA under the Freedom of Information Act. It was reported that on 13-Apr-2007 a 12 year old female was vaccinated with the first dose of GARDASIL (lot# 656049/0187U) 0.5 mL, injection. Concomitant therapy included HAVRIX, (Lot # AHAVB148AA). On 13-APR-2007, the patient fainted and had pseudo seizure like symptoms. The patient had dreams about receiving the shot and the physician felt that the reaction was anxiety related. The patient had the following laboratory diagnostic tests performed after the incident: glucose 85, blood pressure 135/75 mm Hg, pulse 85 and one hour later, after the incident the blood pressure was 97/63 mm Hg, pulse 73, oxygen saturation (pulse oximetry) was 99% and serum glucose was 85. No BENADRYL was given to the patient. Subseqeuntly the patient recovered from the events that same day. Conversion disorder, Nightmare and syncope were considered non-serious. VAERS # 277319. This is a consolidation of two reports concerning the same patient. Additional information has been requested.


Changed on 6/14/2014

277319 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:New Mexico
Vaccinated:2007-04-13
Onset:2007-04-13
Submitted:2007-04-24
Entered:2007-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB148AA / 0 LA / IJ
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0187U / 0 UN / IJ

Administered by: Private      Purchased by: Other
Symptoms: Dizziness, Loss of consciousness, 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)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: No concurrent medication
Current Illness: Unknown
Preexisting Conditions: The subject was reported to be "otherwise healthy". The subject experienced no adverse events following previous vaccinations.
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': A0647898A

Write-up:This case was reported by a physician and described the occurrence of unconscious in a 12-year-old female subject who was vaccinated with Havrix, Gardasil for prophylaxis. The subject was reported to be "otherwise healthy". The subject experienced on adverse events following previous vaccinations. There were no concurrent medications. On 13 April 2007 at 11:00, the subject received the 1st dose of Havrix (.5 ml, unknown, left arm). On 13 April 2007 at an unspecified time, the subject received the 1st dose of Gardasil. On 13 April 2007, 2 minutes after vaccination with Havrix and an unspecified time after vaccination with Gardasil, the subject experienced two episodes of dizziness and fainting within five minutes of dosing. The subject was unconscious for a minute or less with each episode. This case was assessed as medically serious by manufacturer. On 13 April 2007, the events were resolved. 06/17/10 Follow-up information was identified from a line listing obtained on request by the Company from the FDA under the Freedom of Information Act. It was reported that on 13-Apr-2007 a 12 year old female was vaccinated with the first dose of GARDASIL (lot# 656049/0187U) 0.5 mL, injection. Concomitant therapy included HAVRIX, (Lot # AHAVB148AA). On 13-APR-2007, the patient fainted and had pseudo seizure like symptoms. The patient had dreams about receiving the shot and the physician felt that the reaction was anxiety related. The patient had the following laboratory diagnostic tests performed after the incident: glucose 85, blood pressure 135/75 mm Hg, pulse 85 and one hour later, after the incident the blood pressure was 97/63 mm Hg, pulse 73, oxygen saturation (pulse oximetry) was 99% and serum glucose was 85. No BENADRYL was given to the patient. Subseqeuntly the patient recovered from the events that same day. Conversion disorder, Nightmare and syncope were considered non-serious. VAERS # 277319. This is a consolidation of two reports concerning the same patient. Additional information has been requested.


Changed on 5/14/2017

277319 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:New Mexico
Vaccinated:2007-04-13
Onset:2007-04-13
Submitted:2007-04-24
Entered:2007-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB148AA / 0 LA / IJ
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0187U / 0 UN / IJ

Administered by: Private      Purchased by: Other
Symptoms: Dizziness, Loss of consciousness, 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)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: No concurrent medication
Current Illness: Unknown
Preexisting Conditions: The subject was reported to be "otherwise healthy". The subject experienced no adverse events following previous vaccinations.
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': A0647898A

Write-up:This case was reported by a physician and described the occurrence of unconscious in a 12-year-old female subject who was vaccinated with Havrix, Gardasil for prophylaxis. The subject was reported to be "otherwise healthy". The subject experienced on adverse events following previous vaccinations. There were no concurrent medications. On 13 April 2007 at 11:00, the subject received the 1st dose of Havrix (.5 ml, unknown, left arm). On 13 April 2007 at an unspecified time, the subject received the 1st dose of Gardasil. On 13 April 2007, 2 minutes after vaccination with Havrix and an unspecified time after vaccination with Gardasil, the subject experienced two episodes of dizziness and fainting within five minutes of dosing. The subject was unconscious for a minute or less with each episode. This case was assessed as medically serious by manufacturer. On 13 April 2007, the events were resolved. 06/17/10 Follow-up information was identified from a line listing obtained on request by the Company from the FDA under the Freedom of Information Act. It was reported that on 13-Apr-2007 a 12 year old female was vaccinated with the first dose of GARDASIL (lot# 656049/0187U) 0.5 mL, injection. Concomitant therapy included HAVRIX, (Lot # AHAVB148AA). On 13-APR-2007, the patient fainted and had pseudo seizure like symptoms. The patient had dreams about receiving the shot and the physician felt that the reaction was anxiety related. The patient had the following laboratory diagnostic tests performed after the incident: glucose 85, blood pressure 135/75 mm Hg, pulse 85 and one hour later, after the incident the blood pressure was 97/63 mm Hg, pulse 73, oxygen saturation (pulse oximetry) was 99% and serum glucose was 85. No BENADRYL was given to the patient. Subseqeuntly the patient recovered from the events that same day. Conversion disorder, Nightmare and syncope were considered non-serious. VAERS # 277319. This is a consolidation of two reports concerning the same patient. Additional information has been requested.


Changed on 9/14/2017

277319 Before After
VAERS Form:(blank) 1
Age:12.0
Gender:Female
Location:New Mexico
Vaccinated:2007-04-13
Onset:2007-04-13
Submitted:2007-04-24
Entered:2007-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB148AA / 0 1 LA / IJ
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0187U / 0 1 UN / IJ

Administered by: Private      Purchased by: Other
Symptoms: Dizziness, Loss of consciousness, 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)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: No concurrent medication
Current Illness: Unknown
Preexisting Conditions: The subject was reported to be "otherwise healthy". The subject experienced no adverse events following previous vaccinations.
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': A0647898A

Write-up:This case was reported by a physician and described the occurrence of unconscious in a 12-year-old female subject who was vaccinated with Havrix, Gardasil for prophylaxis. The subject was reported to be "otherwise healthy". The subject experienced on adverse events following previous vaccinations. There were no concurrent medications. On 13 April 2007 at 11:00, the subject received the 1st dose of Havrix (.5 ml, unknown, left arm). On 13 April 2007 at an unspecified time, the subject received the 1st dose of Gardasil. On 13 April 2007, 2 minutes after vaccination with Havrix and an unspecified time after vaccination with Gardasil, the subject experienced two episodes of dizziness and fainting within five minutes of dosing. The subject was unconscious for a minute or less with each episode. This case was assessed as medically serious by manufacturer. On 13 April 2007, the events were resolved. 06/17/10 Follow-up information was identified from a line listing obtained on request by the Company from the FDA under the Freedom of Information Act. It was reported that on 13-Apr-2007 a 12 year old female was vaccinated with the first dose of GARDASIL (lot# 656049/0187U) 0.5 mL, injection. Concomitant therapy included HAVRIX, (Lot # AHAVB148AA). On 13-APR-2007, the patient fainted and had pseudo seizure like symptoms. The patient had dreams about receiving the shot and the physician felt that the reaction was anxiety related. The patient had the following laboratory diagnostic tests performed after the incident: glucose 85, blood pressure 135/75 mm Hg, pulse 85 and one hour later, after the incident the blood pressure was 97/63 mm Hg, pulse 73, oxygen saturation (pulse oximetry) was 99% and serum glucose was 85. No BENADRYL was given to the patient. Subseqeuntly the patient recovered from the events that same day. Conversion disorder, Nightmare and syncope were considered non-serious. VAERS # 277319. This is a consolidation of two reports concerning the same patient. Additional information has been requested.


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