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This is VAERS ID 277575

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

277575
VAERS Form:
Age:13.0
Gender:Female
Location:Unknown
Vaccinated:2007-03-07
Onset:2007-03-07
Submitted:2007-04-27
Entered:2007-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0188U / 0 - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Convulsion, Loss of consciousness, Muscle twitching, Oxygen saturation, Gaze palsy

Life Threatening? Yes
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: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: pulse oximetry 03/07/07 80%; pulse oximetry 03/07/07 100%
CDC 'Split Type':

Write-up:Information has been received from a licensed practical nurse (LPN) concerning a 13 year old female patient who on 07-MAR-2007 was vaccinated IM in the right deltoid with the first dose, 0.5ml, of Gardasil (Lot #657006/0188U). There was no concomitant med"ication. The nurse reported that on 07-MAR-2007, 10 minutes after the vaccine was administered, the patient complained of an upset stomach, and then passed out. The nurse reported that the patient''''s breathing was normal, but she did not regain conscious


Changed on 12/8/2009

277575 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Unknown
Vaccinated:2007-03-07
Onset:2007-03-07
Submitted:2007-04-27
Entered:2007-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0188U / 0 - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Convulsion, Loss of consciousness, Muscle twitching, Oxygen saturation, Stomach discomfort, Unresponsive to stimuli, Oxygen supplementation, Gaze palsy

Life Threatening? Yes
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: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: pulse oximetry 03/07/07 80%; pulse oximetry 03/07/07 100%
CDC 'Split Type': (blank) WAES0704USA03910

Write-up:Information has been received from a licensed practical nurse (LPN) concerning a 13 year old female patient who on 07-MAR-2007 was vaccinated IM in the right deltoid with the first dose, 0.5ml, of Gardasil (Lot #657006/0188U). There was no concomitant med"ication. medication. The nurse reported that on 07-MAR-2007, 10 minutes after the vaccine was administered, the patient complained of an upset stomach, and then passed out. The nurse reported that the patient''''s patient''s breathing was normal, but she did not regain conscious or respond to verbal stimulation; "the patient''s eyes then "rolled back in her head and she began twitching with seizure like activity." The patient''s pulse oximetry results were between 80# to 100%, and oxygen was administered. The nurse stated that 911 was called, and an intravenous line was started with Valium, 10 mg, administered prior to the ambulance arrival. The patient was taken to the ER, but was not admitted, and her symptoms "lasted at least 20 minutes." The nurse confirmed that the patient had recovered on the same day, 07-MAR-2007, and added that on 12-APR-2007, when the patient returned to the office, her exam revealed no symptoms. The nurse considered the events to be life threatening, and an other important medical event. Additional information has been requested.


Changed on 9/14/2017

277575 Before After
VAERS Form:(blank) 1
Age:13.0
Gender:Female
Location:Unknown
Vaccinated:2007-03-07
Onset:2007-03-07
Submitted:2007-04-27
Entered:2007-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0188U / 0 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Convulsion, Loss of consciousness, Muscle twitching, Oxygen saturation, Stomach discomfort, Unresponsive to stimuli, Oxygen supplementation, Gaze palsy

Life Threatening? Yes
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: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: pulse oximetry 03/07/07 80%; pulse oximetry 03/07/07 100%
CDC 'Split Type': WAES0704USA03910

Write-up:Information has been received from a licensed practical nurse (LPN) concerning a 13 year old female patient who on 07-MAR-2007 was vaccinated IM in the right deltoid with the first dose, 0.5ml, of Gardasil (Lot #657006/0188U). There was no concomitant medication. The nurse reported that on 07-MAR-2007, 10 minutes after the vaccine was administered, the patient complained of an upset stomach, and then passed out. The nurse reported that the patient''s breathing was normal, but she did not regain conscious or respond to verbal stimulation; "the patient''s eyes then "rolled back in her head and she began twitching with seizure like activity." The patient''s pulse oximetry results were between 80# to 100%, and oxygen was administered. The nurse stated that 911 was called, and an intravenous line was started with Valium, 10 mg, administered prior to the ambulance arrival. The patient was taken to the ER, but was not admitted, and her symptoms "lasted at least 20 minutes." The nurse confirmed that the patient had recovered on the same day, 07-MAR-2007, and added that on 12-APR-2007, when the patient returned to the office, her exam revealed no symptoms. The nurse considered the events to be life threatening, and an other important medical event. Additional information has been requested.


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