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This is VAERS ID 281660

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

281660
VAERS Form:
Age:17.0
Gender:Female
Location:California
Vaccinated:2007-05-15
Onset:2007-05-15
Submitted:2007-06-11
Entered:2007-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0181U / 0 UN / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR - / - UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Loss of consciousness, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: ZYRTEC, VITAMINS
Current Illness:
Preexisting Conditions: Drug hypersensitivity to Benzaclin; underwent ear irrigation during visit.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:This information was received from manufacturer on 07 June 2007 under the manufacturer number WAES0705USA03292. /"Information has been received from a physician, concerning a 17 year old female patient, with a drug hypersensitivity to clindamycin/benzylpe"roxide (BENZACLIN), who on 15-MAY-2007 was vaccinated with Gardasil (Lot #656371/0181U). Concomitant therapy involved an ear irrigation at the visit, and also included ADACEL, cetirizine hydrochloride (ZYRTEC) and vitamins (unspecified medications, over t


Changed on 12/8/2009

281660 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:California
Vaccinated:2007-05-15
Onset:2007-05-15
Submitted:2007-06-11
Entered:2007-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0181U / 0 UN / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR - / - UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Loss of consciousness, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: ZYRTEC, VITAMINS
Current Illness:
Preexisting Conditions: Drug hypersensitivity to Benzaclin; underwent ear irrigation during visit.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 200702108

Write-up:This information was received from manufacturer on 07 June 2007 under the manufacturer number WAES0705USA03292. /"Information "Information has been received from a physician, concerning a 17 year old female patient, with a drug hypersensitivity to clindamycin/benzylpe"roxide clindamycin/benzylperoxide (BENZACLIN), who on 15-MAY-2007 was vaccinated with Gardasil (Lot #656371/0181U). Concomitant therapy involved an ear irrigation at the visit, and also included ADACEL, cetirizine hydrochloride (ZYRTEC) and vitamins (unspecified medications, over t the counter). The physician reported that the patient "Seemed fine" immediately after the vaccine was administered, but 5 to 10 minutes later when she was checking out, the patient "fainted and almost hit her head on the counter;" she was unconscious for a few seconds. The patient was taken to the emergency room for evaluation and was released and considered to be recovered on the same day, 15-MAY-2007. The physician considered the event of "fainted and almost hit her head on the counter," to be disabling/incapacitating, and an other important medical event. Additional information has been requested."


Changed on 9/14/2017

281660 Before After
VAERS Form:(blank) 1
Age:17.0
Gender:Female
Location:California
Vaccinated:2007-05-15
Onset:2007-05-15
Submitted:2007-06-11
Entered:2007-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0181U / 0 1 UN / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR - / - UNK UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Loss of consciousness, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: ZYRTEC, VITAMINS
Current Illness:
Preexisting Conditions: Drug hypersensitivity to Benzaclin; underwent ear irrigation during visit.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 200702108

Write-up:This information was received from manufacturer on 07 June 2007 under the manufacturer number WAES0705USA03292. "Information has been received from a physician, concerning a 17 year old female patient, with a drug hypersensitivity to clindamycin/benzylperoxide (BENZACLIN), who on 15-MAY-2007 was vaccinated with Gardasil (Lot #656371/0181U). Concomitant therapy involved an ear irrigation at the visit, and also included ADACEL, cetirizine hydrochloride (ZYRTEC) and vitamins (unspecified medications, over the counter). The physician reported that the patient "Seemed fine" immediately after the vaccine was administered, but 5 to 10 minutes later when she was checking out, the patient "fainted and almost hit her head on the counter;" she was unconscious for a few seconds. The patient was taken to the emergency room for evaluation and was released and considered to be recovered on the same day, 15-MAY-2007. The physician considered the event of "fainted and almost hit her head on the counter," to be disabling/incapacitating, and an other important medical event. Additional information has been requested."


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