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This is VAERS ID 284468

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

284468
VAERS Form:
Age:15.0
Gender:Female
Location:Michigan
Vaccinated:2007-05-08
Onset:2007-05-08
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1161F / 0 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Laceration, Syncope, Suture insertion, 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: Ear tube insertion
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type': WAES0705USA04339

Write-up:Information has been received from a licensed practical nurse concerning a 15 year old female with a history of ear tube surgery as a child and with no known drug allergies who on 08-MAY-2007 was vaccinated IM with a first 0.5 ml dose of Gardasil (Lot# 654540/1161F). The patient fainted 7 to 10 minutes after receiving the vaccine and sustained a laceration of her lower lip. The laceration was repaired in the office by placement of 4 sutures. On 14-MAY-2007, the sutures were removed, the laceration was completely healed without complication and the patient fully recovered. No laboratory diagnostic studies were performed. No product quality complaint was involved. Additional information has been requested.


Changed on 9/14/2017

284468 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:Michigan
Vaccinated:2007-05-08
Onset:2007-05-08
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1161F / 0 1 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Laceration, Syncope, Suture insertion, 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: Ear tube insertion
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type': WAES0705USA04339

Write-up:Information has been received from a licensed practical nurse concerning a 15 year old female with a history of ear tube surgery as a child and with no known drug allergies who on 08-MAY-2007 was vaccinated IM with a first 0.5 ml dose of Gardasil (Lot# 654540/1161F). The patient fainted 7 to 10 minutes after receiving the vaccine and sustained a laceration of her lower lip. The laceration was repaired in the office by placement of 4 sutures. On 14-MAY-2007, the sutures were removed, the laceration was completely healed without complication and the patient fully recovered. No laboratory diagnostic studies were performed. No product quality complaint was involved. Additional information has been requested.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=284468&WAYBACKHISTORY=ON


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