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This is VAERS ID 284017

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

284017
VAERS Form:
Age:12.0
Gender:Female
Location:Illinois
Vaccinated:2007-07-06
Onset:2007-07-06
Submitted:2007-07-06
Entered:2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0211U / 0 LA / IM

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

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:Within one minute of receiving HPV vaccine, pt. had a sycopal episode, with LOC for 1-2 minutes, immediately followed by vomiting. Pt. observed for 15 min. and made complete recovery.


Changed on 12/8/2009

284017 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Illinois
Vaccinated:2007-07-06
Onset:2007-07-06
Submitted:2007-07-06
Entered:2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0211U / 0 LA / IM

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

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:Within one minute of receiving HPV vaccine, pt. had a sycopal episode, with LOC for 1-2 minutes, immediately followed by vomiting. Pt. observed for 15 min. and made complete recovery.


Changed on 9/14/2017

284017 Before After
VAERS Form:(blank) 1
Age:12.0
Gender:Female
Location:Illinois
Vaccinated:2007-07-06
Onset:2007-07-06
Submitted:2007-07-06
Entered:2007-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0211U / 0 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Loss of consciousness, Syncope, Vomiting

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:Within one minute of receiving HPV vaccine, pt. had a sycopal episode, with LOC for 1-2 minutes, immediately followed by vomiting. Pt. observed for 15 min. and made complete recovery.


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