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This is VAERS ID 282180

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

282180
VAERS Form:
Age:15.0
Gender:Female
Location:Wisconsin
Vaccinated:2007-06-18
Onset:2007-06-18
Submitted:2007-06-18
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0388U / 0 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2632AA / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:ADMIN HPV AND TDAP VACCINE, WITHIN ONE MIN OF ADMIN CHILD FAINTED INTO FATHERS ARMS, PT OBSERVED FOR 15 ADDITIONAL MIN WITH NO PROBLEMS. VITALS WNL.


Changed on 12/8/2009

282180 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Wisconsin
Vaccinated:2007-06-18
Onset:2007-06-18
Submitted:2007-06-18
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0388U / 0 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2632AA / 0 LA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:ADMIN HPV AND TDAP VACCINE, WITHIN ONE MIN OF ADMIN CHILD FAINTED INTO FATHERS ARMS, PT OBSERVED FOR 15 ADDITIONAL MIN WITH NO PROBLEMS. VITALS WNL.


Changed on 2/5/2010

282180 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Wisconsin
Vaccinated:2007-06-18
Onset:2007-06-18
Submitted:2007-06-18
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0388U / 0 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2632AA / 0 LA / IM

Administered by: Private Unknown      Purchased by: Private Unknown
Symptoms: 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:ADMIN HPV AND TDAP VACCINE, WITHIN ONE MIN OF ADMIN CHILD FAINTED INTO FATHERS ARMS, PT OBSERVED FOR 15 ADDITIONAL MIN WITH NO PROBLEMS. VITALS WNL. This is in follo-up to report (s) previously submitted on 10/12/2007. Information has been received from a registered nurse concerning a 15 year old female with no medical history or allergies who on 18-JUN-2007 was vaccinated IM into the left deltoid with a first 0.5 ml dose of GARDASIL (lot# 657622/0388U). Concomitant medication given IM into the left deltoid included the first dose of ADACEL (batch c2632AA). Approximately one minute after getting the vaccine the patient fainted for a few seconds. The patient was observed in the office for 15 minutes and fully recovered. Unspecified medical attention was sought and no treatment was needed. No diagnostic laboratory studies were performed. It was reported that the patient was vaccinated with a second dose of the vaccine on 20-AUG-2007 amd experienced no events. No quality complaint was involved. Additional information is not expected.


Changed on 9/14/2017

282180 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:Wisconsin
Vaccinated:2007-06-18
Onset:2007-06-18
Submitted:2007-06-18
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0388U / 0 1 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2632AA / 0 1 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:ADMIN HPV AND TDAP VACCINE, WITHIN ONE MIN OF ADMIN CHILD FAINTED INTO FATHERS ARMS, PT OBSERVED FOR 15 ADDITIONAL MIN WITH NO PROBLEMS. VITALS WNL. This is in follo-up to report (s) previously submitted on 10/12/2007. Information has been received from a registered nurse concerning a 15 year old female with no medical history or allergies who on 18-JUN-2007 was vaccinated IM into the left deltoid with a first 0.5 ml dose of GARDASIL (lot# 657622/0388U). Concomitant medication given IM into the left deltoid included the first dose of ADACEL (batch c2632AA). Approximately one minute after getting the vaccine the patient fainted for a few seconds. The patient was observed in the office for 15 minutes and fully recovered. Unspecified medical attention was sought and no treatment was needed. No diagnostic laboratory studies were performed. It was reported that the patient was vaccinated with a second dose of the vaccine on 20-AUG-2007 amd experienced no events. No quality complaint was involved. Additional information is not expected.


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