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This is VAERS ID 284163

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

284163
VAERS Form:
Age:14.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-05-19
Onset:2007-05-19
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Blood pressure, Heart rate, Syncope

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, 05/19/07, 110/70; total heartbeat count, 05/19/07, 72
CDC 'Split Type': WAES0705USA03876

Write-up:Information has been received from a physician concerning a 14 year old female who on 19-MAY-2007 was vaccinated with the 1st dose Gardasil. There was no concomitant medication nor pertinent medical history. Subsequently the patient experienced syncopal episode within 5 minutes. Blood pressure was 110/70 and pulse rate was 72. Unspecified medical attention was sought and no treatment was required. Subsequently, the patient recovered from syncopal episode. Additional information has been requested.


Changed on 9/14/2017

284163 Before After
VAERS Form:(blank) 1
Age:14.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-05-19
Onset:2007-05-19
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 1 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Blood pressure, Heart rate, Syncope

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, 05/19/07, 110/70; total heartbeat count, 05/19/07, 72
CDC 'Split Type': WAES0705USA03876

Write-up:Information has been received from a physician concerning a 14 year old female who on 19-MAY-2007 was vaccinated with the 1st dose Gardasil. There was no concomitant medication nor pertinent medical history. Subsequently the patient experienced syncopal episode within 5 minutes. Blood pressure was 110/70 and pulse rate was 72. Unspecified medical attention was sought and no treatment was required. Subsequently, the patient recovered from syncopal episode. Additional information has been requested.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=284163&WAYBACKHISTORY=ON


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