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This is VAERS ID 284159

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

284159
VAERS Form:
Age:15.0
Gender:Female
Location:Texas
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Syncope, Ophthalmological examination

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Ophthalmological exam
CDC 'Split Type': WAES0705USA03795

Write-up:Information has been received from a physician concerning a 15 year old female patient who was vaccinated with a 0.5 ml dose of Gardasil. Subsequently, the patient fainted after receiving the vaccine. Unspecified medical attention was sought. Laboratory diagnostic studies included an eye exam. On an unspecified date, the patient recovered. No product quality complaint was involved. Additional information has been requested.


Changed on 9/14/2017

284159 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:Texas
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Syncope, Ophthalmological examination

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Ophthalmological exam
CDC 'Split Type': WAES0705USA03795

Write-up:Information has been received from a physician concerning a 15 year old female patient who was vaccinated with a 0.5 ml dose of Gardasil. Subsequently, the patient fainted after receiving the vaccine. Unspecified medical attention was sought. Laboratory diagnostic studies included an eye exam. On an unspecified date, the patient recovered. No product quality complaint was involved. Additional information has been requested.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=284159&WAYBACKHISTORY=ON


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