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This is VAERS ID 284564

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

284564
VAERS Form:
Age:15.0
Gender:Female
Location:New York
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / UN

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

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

Write-up:Information has been received from a physician concerning a 15 year old female who was vaccinated with Gardasil. It was reported that /"Patient experienced dizziness, vomiting and lost consciousness for short period of time after receiving Gardasil. It is"not known which dose this was in the series./" Lot number was not available. Unspecified medical attention was sought. No further information was provided. Additional information has been requested.


Changed on 12/8/2009

284564 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:New York
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) WAES0706USA00267

Write-up:Information has been received from a physician concerning a 15 year old female who was vaccinated with Gardasil. It was reported that /"Patient "Patient experienced dizziness, vomiting and lost consciousness for short period of time after receiving Gardasil. It is"not is not known which dose this was in the series./" series." Lot number was not available. Unspecified medical attention was sought. No further information was provided. Additional information has been requested.


Changed on 3/2/2010

284564 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:New York
Vaccinated:0000-00-00 2007-05-30
Onset:0000-00-00 2007-05-30
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - 1426F / - 0 UN LA / UN IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR - / 0 RA / IM

Administered by: Unknown Private      Purchased by: Unknown Private
Symptoms: Dizziness, Loss of consciousness, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No No
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: Unknown
Current Illness:
Preexisting Conditions: Unknown None
Allergies:
Diagnostic Lab Data: blood pressure, normal
CDC 'Split Type': WAES0706USA00267

Write-up:Information has been received from a physician concerning a 15 year old female with no drug allergies and no medical history, who on 30-MAY-2007 was vaccinated intramuscularly into the left arm with Gardasil. a first dose of Gardasil (Lot# 655205/1426F). Concomitant vaccination included a first dose of MENACTRA intramuscularly into the right arm. It was reported that "Patient experienced dizziness, vomiting vomiting, burning with injection of vaccine and lost consciousness consciousness. The patient turned very pale and began to bob up and down on her legs. Her blood pressure was taken, which was normal. The patient felt very tired and just wanted to lay down for short period of time after receiving Gardasil. It is not known which dose this was awhile. The color returned to her face, she sat up in the series." Lot number was not available. chair and after approximately 15-20 minutes later she walked out of the office on her own. There were no illnesses at the time of the vaccinations. Unspecified medical attention was sought. No further information was provided. Additional information has been requested. Additional information is not expected.


Changed on 4/7/2010

284564 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:New York
Vaccinated:2007-05-30
Onset:2007-05-30
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1426F / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / 0 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Blood pressure normal, Dizziness, Fatigue, Loss of consciousness, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: blood pressure, normal
CDC 'Split Type': WAES0706USA00267

Write-up:Information has been received from a physician concerning a 15 year old female with no drug allergies and no medical history, who on 30-MAY-2007 was vaccinated intramuscularly into the left arm with a first dose of Gardasil (Lot# 655205/1426F). Concomitant vaccination included a first dose of MENACTRA intramuscularly into the right arm. It was reported that "Patient experienced dizziness, vomiting, burning with injection of vaccine and lost consciousness. The patient turned very pale and began to bob up and down on her legs. Her blood pressure was taken, which was normal. The patient felt very tired and just wanted to lay down for awhile. The color returned to her face, she sat up in the chair and after approximately 15-20 minutes later she walked out of the office on her own. There were no illnesses at the time of the vaccinations. Unspecified medical attention was sought. No further information was provided. Additional information has been requested. Additional information is not expected.


Changed on 9/14/2017

284564 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:New York
Vaccinated:2007-05-30
Onset:2007-05-30
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1426F / 0 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / 0 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Blood pressure normal, Dizziness, Fatigue, Loss of consciousness, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: blood pressure, normal
CDC 'Split Type': WAES0706USA00267

Write-up:Information has been received from a physician concerning a 15 year old female with no drug allergies and no medical history, who on 30-MAY-2007 was vaccinated intramuscularly into the left arm with a first dose of Gardasil (Lot# 655205/1426F). Concomitant vaccination included a first dose of MENACTRA intramuscularly into the right arm. It was reported that "Patient experienced dizziness, vomiting, burning with injection of vaccine and lost consciousness. The patient turned very pale and began to bob up and down on her legs. Her blood pressure was taken, which was normal. The patient felt very tired and just wanted to lay down for awhile. The color returned to her face, she sat up in the chair and after approximately 15-20 minutes later she walked out of the office on her own. There were no illnesses at the time of the vaccinations. Unspecified medical attention was sought. No further information was provided. Additional information has been requested. Additional information is not expected.


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