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This is VAERS ID 284535

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

284535
VAERS Form:
Age:13.0
Gender:Female
Location:Washington
Vaccinated:2007-05-25
Onset:2007-05-26
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 - / -

Administered by: Other      Purchased by: Unknown
Symptoms: Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Current Illness:
Preexisting Conditions: Lightheadedness
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up:Information has been received from a Nurse Practitioner concerning a 13 year old female with a history of lightheadedness who on 25-MAY-2007 was vaccinated with the first dose of Gardasil 0.5 ml. Concomitant therapy included DTaP (unspecified) and Menactr"a. The physician reported that the patient fainted the day after receiving the vaccine. The patient was sitting and fainted when she stood up. The patient sought unspecified medical attention. As of 30-MAY-2007 the patient had recovered. Additional inform


Changed on 12/8/2009

284535 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Washington
Vaccinated:2007-05-25
Onset:2007-05-26
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 - / -

Administered by: Other      Purchased by: Unknown Other
Symptoms: Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Current Illness:
Preexisting Conditions: Lightheadedness
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': (blank) WAES0705USA05726

Write-up:Information has been received from a Nurse Practitioner concerning a 13 year old female with a history of lightheadedness who on 25-MAY-2007 was vaccinated with the first dose of Gardasil 0.5 ml. Concomitant therapy included DTaP (unspecified) and Menactr"a. Menactra. The physician reported that the patient fainted the day after receiving the vaccine. The patient was sitting and fainted when she stood up. The patient sought unspecified medical attention. As of 30-MAY-2007 the patient had recovered. Additional inform information has been requested.


Changed on 9/14/2017

284535 Before After
VAERS Form:(blank) 1
Age:13.0
Gender:Female
Location:Washington
Vaccinated:2007-05-25
Onset:2007-05-26
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 1 - / -

Administered by: Other      Purchased by: Other
Symptoms: Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Current Illness:
Preexisting Conditions: Lightheadedness
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0705USA05726

Write-up:Information has been received from a Nurse Practitioner concerning a 13 year old female with a history of lightheadedness who on 25-MAY-2007 was vaccinated with the first dose of Gardasil 0.5 ml. Concomitant therapy included DTaP (unspecified) and Menactra. The physician reported that the patient fainted the day after receiving the vaccine. The patient was sitting and fainted when she stood up. The patient sought unspecified medical attention. As of 30-MAY-2007 the patient had recovered. Additional information has been requested.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=284535&WAYBACKHISTORY=ON


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