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This is VAERS ID 284537

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

284537
VAERS Form:
Age:14.0
Gender:Female
Location:Unknown
Vaccinated:2007-05-26
Onset:2007-05-26
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Dizziness, Loss of consciousness

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:
CDC 'Split Type':

Write-up:Information has been received from a nurse concerning her 14 year old daughter who on 26-APR-2007 was vaccinated IM with 0.5 ml of Gardasil. On 26-MAY-2007 after she was vaccinated, the patient experienced dizziness and passed out. The patient sought unsp"ecified medical attention. Subsequently, the patient recovered from the events. Additional information has been requested.


Changed on 12/8/2009

284537 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Unknown
Vaccinated:2007-05-26
Onset:2007-05-26
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Dizziness, Loss of consciousness

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:
CDC 'Split Type': (blank) WAES0705USA05737

Write-up:Information has been received from a nurse concerning her 14 year old daughter who on 26-APR-2007 was vaccinated IM with 0.5 ml of Gardasil. On 26-MAY-2007 after she was vaccinated, the patient experienced dizziness and passed out. The patient sought unsp"ecified unspecified medical attention. Subsequently, the patient recovered from the events. Additional information has been requested.


Changed on 2/5/2010

284537 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Unknown Arkansas
Vaccinated:2007-05-26
Onset:2007-05-26
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Dizziness, Loss of consciousness

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:
CDC 'Split Type': WAES0705USA05737

Write-up:Information has been received from a nurse concerning her 14 year old daughter who on 26-APR-2007 was vaccinated IM with 0.5 ml of Gardasil. On 26-MAY-2007 after she was vaccinated, the patient experienced dizziness and passed out. The patient sought unspecified medical attention. Subsequently, the patient recovered from the events. Additional information has been requested. In follow-up it was reported by the licensed practical nurse (LPN), concerning her white, 14 year old, student daughter, whose reported weight was 123 pounds and whose reported height was 65.2 inches who on 26-May-2007 was vaccinated intramuscularly (IM) with 0.5 ml of Gardasil (lot #657622/03880). It was reported that on 25-May-2007 after the patient received the Gardasil, the patient said that she didn''t feel very well and everything was black. She was assisted to a lying position and while she was getting ready to lie down she went limp and passed out for 3 minutes. Her name was called 2-3 times and she came "to". I t was reported thst the patient recovered. Additional information has been requested.


Changed on 7/31/2010

284537 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Arkansas
Vaccinated:2007-05-26
Onset:2007-05-26
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Dizziness, Hypotonia, Loss of consciousness, Malaise

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:
CDC 'Split Type': WAES0705USA05737

Write-up:Information has been received from a nurse concerning her 14 year old daughter who on 26-APR-2007 was vaccinated IM with 0.5 ml of Gardasil. On 26-MAY-2007 after she was vaccinated, the patient experienced dizziness and passed out. The patient sought unspecified medical attention. Subsequently, the patient recovered from the events. Additional information has been requested. In follow-up it was reported by the licensed practical nurse (LPN), concerning her white, 14 year old, student daughter, whose reported weight was 123 pounds and whose reported height was 65.2 inches who on 26-May-2007 was vaccinated intramuscularly (IM) with 0.5 ml of Gardasil (lot #657622/03880). It was reported that on 25-May-2007 after the patient received the Gardasil, the patient said that she didn''t feel very well and everything was black. She was assisted to a lying position and while she was getting ready to lie down she went limp and passed out for 3 minutes. Her name was called 2-3 times and she came "to". I t was reported thst the patient recovered. Additional information has been requested.


Changed on 6/14/2014

284537 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Arkansas
Vaccinated:2007-05-26
Onset:2007-05-26
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Dizziness, Hypotonia, Loss of consciousness, Malaise

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:
CDC 'Split Type': WAES0705USA05737

Write-up:Information has been received from a nurse concerning her 14 year old daughter who on 26-APR-2007 was vaccinated IM with 0.5 ml of Gardasil. On 26-MAY-2007 after she was vaccinated, the patient experienced dizziness and passed out. The patient sought unspecified medical attention. Subsequently, the patient recovered from the events. Additional information has been requested. In follow-up it was reported by the licensed practical nurse (LPN), concerning her white, 14 year old, student daughter, whose reported weight was 123 pounds and whose reported height was 65.2 inches who on 26-May-2007 was vaccinated intramuscularly (IM) with 0.5 ml of Gardasil (lot #657622/03880). It was reported that on 25-May-2007 after the patient received the Gardasil, the patient said that she didn''t feel very well and everything was black. She was assisted to a lying position and while she was getting ready to lie down she went limp and passed out for 3 minutes. Her name was called 2-3 times and she came "to". I t was reported thst the patient recovered. Additional information has been requested.


Changed on 5/14/2017

284537 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Arkansas
Vaccinated:2007-05-26
Onset:2007-05-26
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Dizziness, Hypotonia, Loss of consciousness, Malaise

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:
CDC 'Split Type': WAES0705USA05737

Write-up:Information has been received from a nurse concerning her 14 year old daughter who on 26-APR-2007 was vaccinated IM with 0.5 ml of Gardasil. On 26-MAY-2007 after she was vaccinated, the patient experienced dizziness and passed out. The patient sought unspecified medical attention. Subsequently, the patient recovered from the events. Additional information has been requested. In follow-up it was reported by the licensed practical nurse (LPN), concerning her white, 14 year old, student daughter, whose reported weight was 123 pounds and whose reported height was 65.2 inches who on 26-May-2007 was vaccinated intramuscularly (IM) with 0.5 ml of Gardasil (lot #657622/03880). It was reported that on 25-May-2007 after the patient received the Gardasil, the patient said that she didn''t feel very well and everything was black. She was assisted to a lying position and while she was getting ready to lie down she went limp and passed out for 3 minutes. Her name was called 2-3 times and she came "to". I t was reported thst the patient recovered. Additional information has been requested.


Changed on 9/14/2017

284537 Before After
VAERS Form:(blank) 1
Age:14.0
Gender:Female
Location:Arkansas
Vaccinated:2007-05-26
Onset:2007-05-26
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Dizziness, Hypotonia, Loss of consciousness, Malaise

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:
CDC 'Split Type': WAES0705USA05737

Write-up:Information has been received from a nurse concerning her 14 year old daughter who on 26-APR-2007 was vaccinated IM with 0.5 ml of Gardasil. On 26-MAY-2007 after she was vaccinated, the patient experienced dizziness and passed out. The patient sought unspecified medical attention. Subsequently, the patient recovered from the events. Additional information has been requested. In follow-up it was reported by the licensed practical nurse (LPN), concerning her white, 14 year old, student daughter, whose reported weight was 123 pounds and whose reported height was 65.2 inches who on 26-May-2007 was vaccinated intramuscularly (IM) with 0.5 ml of Gardasil (lot #657622/03880). It was reported that on 25-May-2007 after the patient received the Gardasil, the patient said that she didn''t feel very well and everything was black. She was assisted to a lying position and while she was getting ready to lie down she went limp and passed out for 3 minutes. Her name was called 2-3 times and she came "to". I t was reported thst the patient recovered. Additional information has been requested.


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