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This is VAERS ID 284500

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

284500
VAERS Form:
Age:22.0
Gender:Female
Location:Unknown
Vaccinated:2007-05-25
Onset:2007-05-25
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0389U / - UN / IM

Administered by: Other      Purchased by: Other
Symptoms: 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: TRIPHASIL
Current Illness: Penicillin allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type': WAES0705USA05263

Write-up:Information has been received from a Licensed Practical Nurse (LPN) concerning a 22 year old female with a penicillin allergy and no pertinent medical history who was vaccinated with Gardasil on 25-MAY-2007. Concomitant therapy included TRIPHASIL. The patient fainted five to minutes after receiving her first dose of Gardasil on 25-May-2007. The patient received and fully recovered within 15 minutes. No other information was reported. Additional information has been requested.


Changed on 3/2/2010

284500 Before After
VAERS Form:
Age:22.0
Gender:Female
Location:Unknown New Jersey
Vaccinated:2007-05-25
Onset:2007-05-25
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0389U / - 0 UN LA / IM

Administered by: Other Private      Purchased by: Other Private
Symptoms: 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: TRIPHASIL
Current Illness: Penicillin allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type': WAES0705USA05263

Write-up:Information This is in follow-up to report(s) previously submitted on 6/14/2007. Initial and follow up information has been received from a Licensed Practical Nurse (LPN) concerning a 22 year old female mathematician with a penicillin allergy and no pertinent medical history who was vaccinated with Gardasil on 25-MAY-2007. 25-MAY-2007, IM in to left arm with a first dose of GARDASIL lot #657736/0389U. Concomitant therapy included TRIPHASIL. In follow up it was reported that the patient received injection and remained seated for several minutes after injection. On 25-MAY-2007, at 02:00 PM she walked to front desk area to pay co-pay, while standing patient fell over towards left on nurse. The nurse grabbed patient and lowered to ground. The patient fainted five to minutes after receiving her first dose of Gardasil on 25-May-2007. Patient fainted and the nurse used ammonium acetate to revive patient. The patient received revived and fully recovered within 15 minutes. No other information was reported. Additional information has been requested. Additional information is not expected.


Changed on 4/7/2010

284500 Before After
VAERS Form:
Age:22.0
Gender:Female
Location:New Jersey
Vaccinated:2007-05-25
Onset:2007-05-25
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0389U / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Fall, 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: TRIPHASIL
Current Illness: Penicillin allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type': WAES0705USA05263

Write-up:This is in follow-up to report(s) previously submitted on 6/14/2007. Initial and follow up information has been received from a Licensed Practical Nurse (LPN) concerning a 22 year old female mathematician with a penicillin allergy and no pertinent medical history who was vaccinated with Gardasil on 25-MAY-2007, IM in to left arm with a first dose of GARDASIL lot #657736/0389U. Concomitant therapy included TRIPHASIL. In follow up it was reported that the patient received injection and remained seated for several minutes after injection. On 25-MAY-2007, at 02:00 PM she walked to front desk area to pay co-pay, while standing patient fell over towards left on nurse. The nurse grabbed patient and lowered to ground. The patient fainted five to minutes after receiving her first dose of Gardasil on 25-May-2007. Patient fainted and the nurse used ammonium acetate to revive patient. The patient revived and fully recovered within 15 minutes. No other information was reported. Additional information has been requested. Additional information is not expected.


Changed on 6/14/2014

284500 Before After
VAERS Form:
Age:22.0
Gender:Female
Location:New Jersey
Vaccinated:2007-05-25
Onset:2007-05-25
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0389U / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Fall, 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: TRIPHASIL
Current Illness: Penicillin allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type': WAES0705USA05263

Write-up:This is in follow-up to report(s) previously submitted on 6/14/2007. Initial and follow up information has been received from a Licensed Practical Nurse (LPN) concerning a 22 year old female mathematician with a penicillin allergy and no pertinent medical history who was vaccinated with Gardasil on 25-MAY-2007, IM in to left arm with a first dose of GARDASIL lot #657736/0389U. Concomitant therapy included TRIPHASIL. In follow up it was reported that the patient received injection and remained seated for several minutes after injection. On 25-MAY-2007, at 02:00 PM she walked to front desk area to pay co-pay, while standing patient fell over towards left on nurse. The nurse grabbed patient and lowered to ground. The patient fainted five to minutes after receiving her first dose of Gardasil on 25-May-2007. Patient fainted and the nurse used ammonium acetate to revive patient. The patient revived and fully recovered within 15 minutes. No other information was reported. Additional information has been requested. Additional information is not expected.


Changed on 5/14/2017

284500 Before After
VAERS Form:
Age:22.0
Gender:Female
Location:New Jersey
Vaccinated:2007-05-25
Onset:2007-05-25
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0389U / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Fall, 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: TRIPHASIL
Current Illness: Penicillin allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type': WAES0705USA05263

Write-up:This is in follow-up to report(s) previously submitted on 6/14/2007. Initial and follow up information has been received from a Licensed Practical Nurse (LPN) concerning a 22 year old female mathematician with a penicillin allergy and no pertinent medical history who was vaccinated with Gardasil on 25-MAY-2007, IM in to left arm with a first dose of GARDASIL lot #657736/0389U. Concomitant therapy included TRIPHASIL. In follow up it was reported that the patient received injection and remained seated for several minutes after injection. On 25-MAY-2007, at 02:00 PM she walked to front desk area to pay co-pay, while standing patient fell over towards left on nurse. The nurse grabbed patient and lowered to ground. The patient fainted five to minutes after receiving her first dose of Gardasil on 25-May-2007. Patient fainted and the nurse used ammonium acetate to revive patient. The patient revived and fully recovered within 15 minutes. No other information was reported. Additional information has been requested. Additional information is not expected.


Changed on 9/14/2017

284500 Before After
VAERS Form:(blank) 1
Age:22.0
Gender:Female
Location:New Jersey
Vaccinated:2007-05-25
Onset:2007-05-25
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0389U / 0 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Fall, 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: TRIPHASIL
Current Illness: Penicillin allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type': WAES0705USA05263

Write-up:This is in follow-up to report(s) previously submitted on 6/14/2007. Initial and follow up information has been received from a Licensed Practical Nurse (LPN) concerning a 22 year old female mathematician with a penicillin allergy and no pertinent medical history who was vaccinated with Gardasil on 25-MAY-2007, IM in to left arm with a first dose of GARDASIL lot #657736/0389U. Concomitant therapy included TRIPHASIL. In follow up it was reported that the patient received injection and remained seated for several minutes after injection. On 25-MAY-2007, at 02:00 PM she walked to front desk area to pay co-pay, while standing patient fell over towards left on nurse. The nurse grabbed patient and lowered to ground. The patient fainted five to minutes after receiving her first dose of Gardasil on 25-May-2007. Patient fainted and the nurse used ammonium acetate to revive patient. The patient revived and fully recovered within 15 minutes. No other information was reported. Additional information has been requested. Additional information is not expected.


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