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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 282867 |
VAERS Form: | |
Age: | 18.0 |
Sex: | 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
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
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
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
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
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
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
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
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
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
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
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
Link To This Search Result:
https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=282867&WAYBACKHISTORY=ON
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