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This is VAERS ID 332141

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

332141
VAERS Form:
Age:13.0
Gender:Female
Location:California
Vaccinated:2008-10-28
Onset:2008-10-28
Submitted:2008-11-12
Entered:2008-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUZONE) / SANOFI PASTEUR U2757AA / - LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1487U / 2 RA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Fall, Syncope, Mouth injury, Immediate post-injection reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
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:
Current Illness: None
Preexisting Conditions: Patient is in special classes.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Patient was given Gardasil, Influenza Vac and PPD. Few minutes after the injections patient fainted and fell to the floor. Mother and the medical assistant were in room. Patient sustained a laceration to her left upper lip and her one incisor broke. Patie"nt needed treatment for laceration at the emergency room after she was transported by paramedics. She also required dental treatment. Full dental treatment has not been done yet. She has seen the dentist, she had xrays. She needs a crown, a root canal in


Changed on 12/8/2009

332141 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:California
Vaccinated:2008-10-28
Onset:2008-10-28
Submitted:2008-11-12
Entered:2008-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUZONE) INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2757AA / - LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1487U / 2 RA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Fall, Syncope, Tooth injury, X-ray, Mouth injury, Immediate post-injection reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
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:
Current Illness: None
Preexisting Conditions: Patient is in special classes.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Patient was given Gardasil, Influenza Vac and PPD. Few minutes after the injections patient fainted and fell to the floor. Mother and the medical assistant were in room. Patient sustained a laceration to her left upper lip and her one incisor broke. Patie"nt Patient needed treatment for laceration at the emergency room after she was transported by paramedics. She also required dental treatment. Full dental treatment has not been done yet. She has seen the dentist, she had xrays. She needs a crown, a root canal in the affected tooth. 12/11/08-records received for DOS 10/28/08-immediately after receipt of vaccine fainted, fell and broke her upper lip and front left incisor. Fainting a second time. Seen in ED. 12/17/08-ER records received for DOS 10/28/08-syncope-lip laceration. loose teeth.


Changed on 7/7/2013

332141 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:California
Vaccinated:2008-10-28
Onset:2008-10-28
Submitted:2008-11-12
Entered:2008-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2757AA / - LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2757AA / - LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1487U / 2 RA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Fall, Syncope, Tooth injury, X-ray, Mouth injury, Immediate post-injection reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
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:
Current Illness: None
Preexisting Conditions: Patient is in special classes.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Patient was given Gardasil, Influenza Vac and PPD. Few minutes after the injections patient fainted and fell to the floor. Mother and the medical assistant were in room. Patient sustained a laceration to her left upper lip and her one incisor broke. Patient needed treatment for laceration at the emergency room after she was transported by paramedics. She also required dental treatment. Full dental treatment has not been done yet. She has seen the dentist, she had xrays. She needs a crown, a root canal in the affected tooth. 12/11/08-records received for DOS 10/28/08-immediately after receipt of vaccine fainted, fell and broke her upper lip and front left incisor. Fainting a second time. Seen in ED. 12/17/08-ER records received for DOS 10/28/08-syncope-lip laceration. loose teeth.


Changed on 9/14/2017

332141 Before After
VAERS Form:(blank) 1
Age:13.0
Gender:Female
Location:California
Vaccinated:2008-10-28
Onset:2008-10-28
Submitted:2008-11-12
Entered:2008-11-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2757AA / - UNK LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1487U / 2 3 RA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Fall, Syncope, Tooth injury, X-ray, Mouth injury, Immediate post-injection reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
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:
Current Illness: None
Preexisting Conditions: Patient is in special classes.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Patient was given Gardasil, Influenza Vac and PPD. Few minutes after the injections patient fainted and fell to the floor. Mother and the medical assistant were in room. Patient sustained a laceration to her left upper lip and her one incisor broke. Patient needed treatment for laceration at the emergency room after she was transported by paramedics. She also required dental treatment. Full dental treatment has not been done yet. She has seen the dentist, she had xrays. She needs a crown, a root canal in the affected tooth. 12/11/08-records received for DOS 10/28/08-immediately after receipt of vaccine fainted, fell and broke her upper lip and front left incisor. Fainting a second time. Seen in ED. 12/17/08-ER records received for DOS 10/28/08-syncope-lip laceration. loose teeth.


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