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This is VAERS ID 284780

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

284780
VAERS Form:
Age:14.0
Gender:Female
Location:Iowa
Vaccinated:2007-06-26
Onset:2007-06-26
Submitted:2007-07-12
Entered:2007-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / UN

Administered by: Public      Purchased by: Unknown
Symptoms: Mydriasis, Pallor, 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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Pt fainted with-in one minute after receiving Gardasil. Her eyes had dilated pupils and her color was pale. She was quickly placed supine. Mother stated she woke her up and brought her in. She had not eaten or had fluids that morning. She was talking afte"r being placed supine and had completely recovered 3 min later.


Changed on 12/8/2009

284780 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Iowa
Vaccinated:2007-06-26
Onset:2007-06-26
Submitted:2007-07-12
Entered:2007-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / UN

Administered by: Public      Purchased by: Unknown Other
Symptoms: Mydriasis, Pallor, 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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Pt fainted with-in one minute after receiving Gardasil. Her eyes had dilated pupils and her color was pale. She was quickly placed supine. Mother stated she woke her up and brought her in. She had not eaten or had fluids that morning. She was talking afte"r after being placed supine and had completely recovered 3 min later.


Changed on 9/14/2017

284780 Before After
VAERS Form:(blank) 1
Age:14.0
Gender:Female
Location:Iowa
Vaccinated:2007-06-26
Onset:2007-06-26
Submitted:2007-07-12
Entered:2007-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UNK UN / UN

Administered by: Public      Purchased by: Other
Symptoms: Mydriasis, Pallor, 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:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Pt fainted with-in one minute after receiving Gardasil. Her eyes had dilated pupils and her color was pale. She was quickly placed supine. Mother stated she woke her up and brought her in. She had not eaten or had fluids that morning. She was talking after being placed supine and had completely recovered 3 min later.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=284780&WAYBACKHISTORY=ON


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