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This is VAERS ID 278022

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

278022
VAERS Form:
Age:19.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-05-04
Onset:2007-05-04
Submitted:2007-05-04
Entered:2007-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0384U / 0 RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Convulsion, Fall, Head injury, Respiratory arrest, 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: None
Current Illness: URI
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Pt had syncopal episode 2 minutes after injection given. Fell and hit back of head-had seizure lasting 1 min was unresponsive, not breathing x 30 min. Administered ammonia pads and called 911


Changed on 12/8/2009

278022 Before After
VAERS Form:
Age:19.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-05-04
Onset:2007-05-04
Submitted:2007-05-04
Entered:2007-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0384U / 0 RA / IM

Administered by: Private      Purchased by: Unknown Other
Symptoms: Convulsion, Fall, Head injury, Respiratory arrest, Syncope, Unresponsive to stimuli

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: None
Current Illness: URI
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Pt had syncopal episode 2 minutes after injection given. Fell and hit back of head-had seizure lasting 1 min was unresponsive, not breathing x 30 min. Administered ammonia pads and called 911


Changed on 9/14/2017

278022 Before After
VAERS Form:(blank) 1
Age:19.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-05-04
Onset:2007-05-04
Submitted:2007-05-04
Entered:2007-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0384U / 0 1 RA / IM

Administered by: Private      Purchased by: Other
Symptoms: Convulsion, Fall, Head injury, Respiratory arrest, Syncope, Unresponsive to stimuli

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: None
Current Illness: URI
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Pt had syncopal episode 2 minutes after injection given. Fell and hit back of head-had seizure lasting 1 min was unresponsive, not breathing x 30 min. Administered ammonia pads and called 911


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