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This is VAERS ID 288762

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 288762
VAERS Form:
Age:15.0
Sex:Female
Location:Iowa
Vaccinated:2007-08-06
Onset:2007-08-06
Submitted:2007-08-22
Entered:2007-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1427F / 0 UN / UN
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Other      Purchased by: Unknown
Symptoms: Fall, Head injury, Inappropriate schedule of drug administration, Neurological examination

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: neurological 08/06/07 - result not reported; physical examination 08/06/07 - cardiology: result not reported
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 15 year old female who on 06-AUG-2007 was vaccinated with first dose of Gardasil (lot # 655619/1427F) injection. Concomitant therapy also given on 06-AUG-2007 included diphtheria toxoid (+) pertu"ssis acellular vaccine (unspecified) (+) tetanus toxoid (manufacturer unknown). On 06-AUG-2007, the patient was sitting on the exam table and was administered the 2 vaccines. The patient fell off the exam table and hit the left side of her head and face.


Changed on 12/8/2009

VAERS ID: 288762 Before After
VAERS Form:
Age:15.0
Sex:Female
Location:Iowa
Vaccinated:2007-08-06
Onset:2007-08-06
Submitted:2007-08-22
Entered:2007-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1427F / 0 UN / UN
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Other      Purchased by: Unknown Other
Symptoms: Fall, Head injury, Inappropriate schedule of drug administration, Neurological examination

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: neurological 08/06/07 - result not reported; physical examination 08/06/07 - cardiology: result not reported
CDC 'Split Type': (blank) WAES0708USA03472

Write-up: Information has been received from a physician concerning a 15 year old female who on 06-AUG-2007 was vaccinated with first dose of Gardasil (lot # 655619/1427F) injection. Concomitant therapy also given on 06-AUG-2007 included diphtheria toxoid (+) pertu"ssis pertussis acellular vaccine (unspecified) (+) tetanus toxoid (manufacturer unknown). On 06-AUG-2007, the patient was sitting on the exam table and was administered the 2 vaccines. The patient fell off the exam table and hit the left side of her head and face. Medical attention was sought (doctor''s office and emergency room). The physician admitted the patient into the hospital for a 23 hour observation. The patient had neurology and cardiology consultations and they performed some tests which are unspecified. On an unspecified date, the patient recovered. Additional information has been requested.


Changed on 9/14/2017

VAERS ID: 288762 Before After
VAERS Form:(blank) 1
Age:15.0
Sex:Female
Location:Iowa
Vaccinated:2007-08-06
Onset:2007-08-06
Submitted:2007-08-22
Entered:2007-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1427F / 0 1 UN / UN
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Fall, Head injury, Inappropriate schedule of drug administration, Neurological examination

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: neurological 08/06/07 - result not reported; physical examination 08/06/07 - cardiology: result not reported
CDC 'Split Type': WAES0708USA03472

Write-up: Information has been received from a physician concerning a 15 year old female who on 06-AUG-2007 was vaccinated with first dose of Gardasil (lot # 655619/1427F) injection. Concomitant therapy also given on 06-AUG-2007 included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid (manufacturer unknown). On 06-AUG-2007, the patient was sitting on the exam table and was administered the 2 vaccines. The patient fell off the exam table and hit the left side of her head and face. Medical attention was sought (doctor''s office and emergency room). The physician admitted the patient into the hospital for a 23 hour observation. The patient had neurology and cardiology consultations and they performed some tests which are unspecified. On an unspecified date, the patient recovered. Additional information has been requested.


Changed on 2/14/2018

VAERS ID: 288762 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Iowa
Vaccinated:2007-08-06
Onset:2007-08-06
Submitted:2007-08-22
Entered:2007-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1427F / 1 UN / UN
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Fall, Head injury, Inappropriate schedule of drug administration, Neurological examination

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: neurological 08/06/07 - result not reported; physical examination 08/06/07 - cardiology: result not reported
CDC 'Split Type': WAES0708USA03472

Write-up: Information has been received from a physician concerning a 15 year old female who on 06-AUG-2007 was vaccinated with first dose of Gardasil (lot # 655619/1427F) injection. Concomitant therapy also given on 06-AUG-2007 included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid (manufacturer unknown). On 06-AUG-2007, the patient was sitting on the exam table and was administered the 2 vaccines. The patient fell off the exam table and hit the left side of her head and face. Medical attention was sought (doctor''s office and emergency room). The physician admitted the patient into the hospital for a 23 hour observation. The patient had neurology and cardiology consultations and they performed some tests which are unspecified. On an unspecified date, the patient recovered. Additional information has been requested.


Changed on 6/14/2018

VAERS ID: 288762 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Iowa
Vaccinated:2007-08-06
Onset:2007-08-06
Submitted:2007-08-22
Entered:2007-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1427F / 1 UN / UN
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Fall, Head injury, Inappropriate schedule of drug administration, Neurological examination

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: neurological 08/06/07 - result not reported; physical examination 08/06/07 - cardiology: result not reported
CDC 'Split Type': WAES0708USA03472

Write-up: Information has been received from a physician concerning a 15 year old female who on 06-AUG-2007 was vaccinated with first dose of Gardasil (lot # 655619/1427F) injection. Concomitant therapy also given on 06-AUG-2007 included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid (manufacturer unknown). On 06-AUG-2007, the patient was sitting on the exam table and was administered the 2 vaccines. The patient fell off the exam table and hit the left side of her head and face. Medical attention was sought (doctor''s office and emergency room). The physician admitted the patient into the hospital for a 23 hour observation. The patient had neurology and cardiology consultations and they performed some tests which are unspecified. On an unspecified date, the patient recovered. Additional information has been requested.


Changed on 8/14/2018

VAERS ID: 288762 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Iowa
Vaccinated:2007-08-06
Onset:2007-08-06
Submitted:2007-08-22
Entered:2007-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1427F / 1 UN / UN
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Fall, Head injury, Inappropriate schedule of drug administration, Neurological examination

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: neurological 08/06/07 - result not reported; physical examination 08/06/07 - cardiology: result not reported
CDC 'Split Type': WAES0708USA03472

Write-up: Information has been received from a physician concerning a 15 year old female who on 06-AUG-2007 was vaccinated with first dose of Gardasil (lot # 655619/1427F) injection. Concomitant therapy also given on 06-AUG-2007 included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid (manufacturer unknown). On 06-AUG-2007, the patient was sitting on the exam table and was administered the 2 vaccines. The patient fell off the exam table and hit the left side of her head and face. Medical attention was sought (doctor''s office and emergency room). The physician admitted the patient into the hospital for a 23 hour observation. The patient had neurology and cardiology consultations and they performed some tests which are unspecified. On an unspecified date, the patient recovered. Additional information has been requested.


Changed on 9/14/2018

VAERS ID: 288762 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Iowa
Vaccinated:2007-08-06
Onset:2007-08-06
Submitted:2007-08-22
Entered:2007-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1427F / 1 UN / UN
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Fall, Head injury, Inappropriate schedule of drug administration, Neurological examination

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: neurological 08/06/07 - result not reported; physical examination 08/06/07 - cardiology: result not reported
CDC 'Split Type': WAES0708USA03472

Write-up: Information has been received from a physician concerning a 15 year old female who on 06-AUG-2007 was vaccinated with first dose of Gardasil (lot # 655619/1427F) injection. Concomitant therapy also given on 06-AUG-2007 included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid (manufacturer unknown). On 06-AUG-2007, the patient was sitting on the exam table and was administered the 2 vaccines. The patient fell off the exam table and hit the left side of her head and face. Medical attention was sought (doctor''s office and emergency room). The physician admitted the patient into the hospital for a 23 hour observation. The patient had neurology and cardiology consultations and they performed some tests which are unspecified. On an unspecified date, the patient recovered. Additional information has been requested.


Changed on 10/14/2018

VAERS ID: 288762 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Iowa
Vaccinated:2007-08-06
Onset:2007-08-06
Submitted:2007-08-22
Entered:2007-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1427F / 1 UN / UN
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Fall, Head injury, Inappropriate schedule of drug administration, Neurological examination

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: neurological 08/06/07 - result not reported; physical examination 08/06/07 - cardiology: result not reported
CDC 'Split Type': WAES0708USA03472

Write-up: Information has been received from a physician concerning a 15 year old female who on 06-AUG-2007 was vaccinated with first dose of Gardasil (lot # 655619/1427F) injection. Concomitant therapy also given on 06-AUG-2007 included diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid (manufacturer unknown). On 06-AUG-2007, the patient was sitting on the exam table and was administered the 2 vaccines. The patient fell off the exam table and hit the left side of her head and face. Medical attention was sought (doctor''s office and emergency room). The physician admitted the patient into the hospital for a 23 hour observation. The patient had neurology and cardiology consultations and they performed some tests which are unspecified. On an unspecified date, the patient recovered. Additional information has been requested.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=288762&WAYBACKHISTORY=ON


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