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This is VAERS ID 284131

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

284131
VAERS Form:
Age:19.0
Gender:Female
Location:Virginia
Vaccinated:2007-05-15
Onset:2007-05-15
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0389U / 0 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Blood pressure, Dizziness, Heart rate, Hyperhidrosis, Pallor, Immediate post-injection reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: blood pressure 05/15/07 98/68 mmHg; total heartbeat count 05/15/07 72 bpm
CDC 'Split Type': WAES0705USA03145

Write-up:Initial and follow up information has been received from a licensed practical nurse and a healthcare professional, concerning a 19 year old white female student, who at 3:15pm on 15-MAY-2007 was vaccinated IM in the left deltoid with the first dose, 0.5ml, of Gardasil (Lot #657736/0389U). There was no concomitant medication, nor illness at the time of vaccination. The nurse originally reported that the patient "passed out" after the vaccination was administered, but the healthcare worker, who also administered the vaccine, confirmed that the patient immediately (at 3:15pm) following the vaccination, became lightheaded, dizzy and pale, and began sweating. The healthcare worker took the patient to a room and gave her a drink and an ice pack; vitals included blood pressure of 98/68, heart rate of 72, and temperature of 98.1F. The patient laid down for 20 minutes and started feeling better. The healthcare worker advised the patient to call for a ride, but she refused; she recovered on the same day, 15-MAY-2007. The patient sought unspecified medical attention. No further information is expected.


Changed on 9/14/2017

284131 Before After
VAERS Form:(blank) 1
Age:19.0
Gender:Female
Location:Virginia
Vaccinated:2007-05-15
Onset:2007-05-15
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0389U / 0 1 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Blood pressure, Dizziness, Heart rate, Hyperhidrosis, Pallor, Immediate post-injection reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: blood pressure 05/15/07 98/68 mmHg; total heartbeat count 05/15/07 72 bpm
CDC 'Split Type': WAES0705USA03145

Write-up:Initial and follow up information has been received from a licensed practical nurse and a healthcare professional, concerning a 19 year old white female student, who at 3:15pm on 15-MAY-2007 was vaccinated IM in the left deltoid with the first dose, 0.5ml, of Gardasil (Lot #657736/0389U). There was no concomitant medication, nor illness at the time of vaccination. The nurse originally reported that the patient "passed out" after the vaccination was administered, but the healthcare worker, who also administered the vaccine, confirmed that the patient immediately (at 3:15pm) following the vaccination, became lightheaded, dizzy and pale, and began sweating. The healthcare worker took the patient to a room and gave her a drink and an ice pack; vitals included blood pressure of 98/68, heart rate of 72, and temperature of 98.1F. The patient laid down for 20 minutes and started feeling better. The healthcare worker advised the patient to call for a ride, but she refused; she recovered on the same day, 15-MAY-2007. The patient sought unspecified medical attention. No further information is expected.


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