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This is VAERS ID 279179

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

279179
VAERS Form:
Age:11.0
Gender:Female
Location:Unknown
Vaccinated:2007-03-26
Onset:2007-03-26
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / UN

Administered by: Other      Purchased by: Unknown
Symptoms: Dizziness, Injection site pain, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up:Information has been received from a Registered Nurse (R.N.) concerning an 11 year old female patient who on 26-MAR-2007 was vaccinated with the first dose of 0.5 mL of Gardasil. The /"patients became light headed and fainted after receiving the dose of G"ardasil./" The nurse reported that the patient had /"experienced 2 weeks of injection site soreness./" Unspecified medical attention was sought by the patient. Injection site soreness persisted. Additional information has been requested.


Changed on 12/8/2009

279179 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:Unknown
Vaccinated:2007-03-26
Onset:2007-03-26
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / UN

Administered by: Other      Purchased by: Unknown Other
Symptoms: Dizziness, Injection site pain, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': (blank) WAES0704USA01490

Write-up:Information has been received from a Registered Nurse (R.N.) concerning an 11 year old female patient who on 26-MAR-2007 was vaccinated with the first dose of 0.5 mL of Gardasil. The /"patients "patients became light headed and fainted after receiving the dose of G"ardasil./" Gardasil." The nurse reported that the patient had /"experienced "experienced 2 weeks of injection site soreness./" soreness." Unspecified medical attention was sought by the patient. Injection site soreness persisted. Additional information has been requested.


Changed on 9/14/2017

279179 Before After
VAERS Form:(blank) 1
Age:11.0
Gender:Female
Location:Unknown
Vaccinated:2007-03-26
Onset:2007-03-26
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Dizziness, Injection site pain, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0704USA01490

Write-up:Information has been received from a Registered Nurse (R.N.) concerning an 11 year old female patient who on 26-MAR-2007 was vaccinated with the first dose of 0.5 mL of Gardasil. The "patients became light headed and fainted after receiving the dose of Gardasil." The nurse reported that the patient had "experienced 2 weeks of injection site soreness." Unspecified medical attention was sought by the patient. Injection site soreness persisted. Additional information has been requested.


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Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=279179&WAYBACKHISTORY=ON


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