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This is VAERS ID 279662

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

279662
VAERS Form:
Age:15.0
Gender:Female
Location:New Jersey
Vaccinated:2007-04-23
Onset:2007-04-23
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / UN

Administered by: Other      Purchased by: Unknown
Symptoms: Cyanosis, Dizziness, Injection site pain, Loss of consciousness, No reaction on previous exposure to drug

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up:Information has been received from a physician concerning a 15 year old female. The patient received her first dose of Gardasil and had no adverse reaction. On the week of 23-APR-2007 the patient was vaccinated with Gardasil second dose. Immediately after"receiving her second dose, the patient''''s arm which received the injection began to hurt, the patient became dizzy and passed out. Her lips turned blue. Unspecified medical attention was sought. The patient was not given any other vaccines on the day she


Changed on 12/8/2009

279662 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:New Jersey
Vaccinated:2007-04-23
Onset:2007-04-23
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / UN

Administered by: Other      Purchased by: Unknown Other
Symptoms: Cyanosis, Dizziness, Injection site pain, Loss of consciousness, No reaction on previous exposure to drug

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': (blank) WAES0705USA00100

Write-up:Information has been received from a physician concerning a 15 year old female. The patient received her first dose of Gardasil and had no adverse reaction. On the week of 23-APR-2007 the patient was vaccinated with Gardasil second dose. Immediately after"receiving after receiving her second dose, the patient''''s patient''s arm which received the injection began to hurt, the patient became dizzy and passed out. Her lips turned blue. Unspecified medical attention was sought. The patient was not given any other vaccines on the day she was given her second dose of Gardasil. Subsequently, the patient recovered from the arm pain, dizziness, passing out and lips turning blue. Additional information has been requested.


Changed on 9/14/2017

279662 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:New Jersey
Vaccinated:2007-04-23
Onset:2007-04-23
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Cyanosis, Dizziness, Injection site pain, Loss of consciousness, No reaction on previous exposure to drug

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0705USA00100

Write-up:Information has been received from a physician concerning a 15 year old female. The patient received her first dose of Gardasil and had no adverse reaction. On the week of 23-APR-2007 the patient was vaccinated with Gardasil second dose. Immediately after receiving her second dose, the patient''s arm which received the injection began to hurt, the patient became dizzy and passed out. Her lips turned blue. Unspecified medical attention was sought. The patient was not given any other vaccines on the day she was given her second dose of Gardasil. Subsequently, the patient recovered from the arm pain, dizziness, passing out and lips turning blue. Additional information has been requested.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=279662&WAYBACKHISTORY=ON


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