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This is VAERS ID 282867

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

282867
VAERS Form:
Age:18.0
Gender:Female
Location:Unknown
Vaccinated:2007-06-14
Onset:2007-06-14
Submitted:2007-06-19
Entered:2007-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0524U / - UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Fall, Head injury, Loss of consciousness

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: healthy female
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Shortly after receiving Gardasil, pt blacked out and fell off exam table where she had been sitting. Her forehead struck the exam table stirrup, breaking it off, her left thigh scrapped against broken metal from stirrup and pt landed on the floor, where w"as found the the nurse


Changed on 12/8/2009

282867 Before After
VAERS Form:
Age:18.0
Gender:Female
Location:Unknown
Vaccinated:2007-06-14
Onset:2007-06-14
Submitted:2007-06-19
Entered:2007-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0524U / - UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Fall, Head injury, Loss of consciousness

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No No
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: healthy female
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Shortly after receiving Gardasil, pt blacked out and fell off exam table where she had been sitting. Her forehead struck the exam table stirrup, breaking it off, her left thigh scrapped against broken metal from stirrup and pt landed on the floor, where w"as was found the the nurse


Changed on 1/5/2010

282867 Before After
VAERS Form:
Age:18.0
Gender:Female
Location:Unknown
Vaccinated:2007-06-14
Onset:2007-06-14
Submitted:2007-06-19
Entered:2007-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0524U / - UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Fall, Head injury, Loss of consciousness

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No 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: healthy female
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Shortly after receiving Gardasil, pt blacked out and fell off exam table where she had been sitting. Her forehead struck the exam table stirrup, breaking it off, her left thigh scrapped against broken metal from stirrup and pt landed on the floor, where was found the the nurse


Changed on 9/14/2017

282867 Before After
VAERS Form:(blank) 1
Age:18.0
Gender:Female
Location:Unknown
Vaccinated:2007-06-14
Onset:2007-06-14
Submitted:2007-06-19
Entered:2007-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0524U / - UNK UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Fall, Head injury, Loss of consciousness

Life Threatening? Yes
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: healthy female
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Shortly after receiving Gardasil, pt blacked out and fell off exam table where she had been sitting. Her forehead struck the exam table stirrup, breaking it off, her left thigh scrapped against broken metal from stirrup and pt landed on the floor, where was found the the nurse


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=282867&WAYBACKHISTORY=ON


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