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This is VAERS ID 289026

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

289026
VAERS Form:
Age:16.0
Gender:Female
Location:Unknown
Vaccinated:2007-08-01
Onset:2007-08-01
Submitted:2007-08-24
Entered:2007-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Grand mal convulsion, Head injury, Heart rate, Heart rate decreased

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: total heartbeat count 08/01/07 43 BPM - PV; total heartbeat 08/01/07 68 BPM - 20 min PV
CDC 'Split Type':

Write-up:Information has been received from a physician concerning a 16 year old female with no known allergies who on 01-AUG-2007 was vaccinated with the first dose of Gardasil (Lot# not provided). No concomitant therapies were reported. The physician reported th"at within 60 seconds post vaccination the patient had a vasal vagal response, experienced a Tonic clonic Grand mal seizure and hit her head on the office wall. The physician reported that at that time the patient was sweating and her pulse was 43 BPM. The


Changed on 12/8/2009

289026 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Unknown
Vaccinated:2007-08-01
Onset:2007-08-01
Submitted:2007-08-24
Entered:2007-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Grand mal convulsion, Head injury, Heart rate, Heart rate decreased, Hyperhidrosis, Syncope vasovagal, Tonic clonic movements

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: total heartbeat count 08/01/07 43 BPM - PV; total heartbeat 08/01/07 68 BPM - 20 min PV
CDC 'Split Type': (blank) WAES0708USA03395

Write-up:Information has been received from a physician concerning a 16 year old female with no known allergies who on 01-AUG-2007 was vaccinated with the first dose of Gardasil (Lot# not provided). No concomitant therapies were reported. The physician reported th"at that within 60 seconds post vaccination the patient had a vasal vagal response, experienced a Tonic clonic Grand mal seizure and hit her head on the office wall. The physician reported that at that time the patient was sweating and her pulse was 43 BPM. The patient laid down and oxygen was administered. The physician reported that the patient was monitored and with 20 minutes her pulse was 68 BPM and she had recovered from the event. The physician considered the event to be disabling and an other important medical event. Additional information has been requested.


Changed on 9/14/2017

289026 Before After
VAERS Form:(blank) 1
Age:16.0
Gender:Female
Location:Unknown
Vaccinated:2007-08-01
Onset:2007-08-01
Submitted:2007-08-24
Entered:2007-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Grand mal convulsion, Head injury, Heart rate, Heart rate decreased, Hyperhidrosis, Syncope vasovagal, Tonic clonic movements

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: total heartbeat count 08/01/07 43 BPM - PV; total heartbeat 08/01/07 68 BPM - 20 min PV
CDC 'Split Type': WAES0708USA03395

Write-up:Information has been received from a physician concerning a 16 year old female with no known allergies who on 01-AUG-2007 was vaccinated with the first dose of Gardasil (Lot# not provided). No concomitant therapies were reported. The physician reported that within 60 seconds post vaccination the patient had a vasal vagal response, experienced a Tonic clonic Grand mal seizure and hit her head on the office wall. The physician reported that at that time the patient was sweating and her pulse was 43 BPM. The patient laid down and oxygen was administered. The physician reported that the patient was monitored and with 20 minutes her pulse was 68 BPM and she had recovered from the event. The physician considered the event to be disabling and an other important medical event. Additional information has been requested.


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