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This is VAERS ID 542913

History of Changes from the VAERS Wayback Machine

First Appeared on 1/14/2015

542913
VAERS Form:
Age:13.0
Gender:Female
Location:Foreign
Vaccinated:2014-03-29
Onset:2014-03-29
Submitted:2014-09-08
Entered:2014-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J011180 / 0 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: No other medications
Current Illness: Immunisation; Syncope
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1409BRA002927

Write-up:This spontaneous report was received from a Physician refers to a 12 year old female patient who experienced syncope. On 29-MAR-2014, the patient was vaccinated with GARDASIL. On 29-MAR-2014 the patient experienced Syncope fifteen (15) minutes after Vaccination. The Outcome of adverse event Syncope was reported as Recovered. The relationship of Syncope with GARDASIL is Unknown. Additional information is not expected.


Changed on 9/14/2017

542913 Before After
VAERS Form:(blank) 1
Age:13.0
Gender:Female
Location:Foreign
Vaccinated:2014-03-29
Onset:2014-03-29
Submitted:2014-09-08
Entered:2014-09-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J011180 / 0 1 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: No other medications
Current Illness: Immunisation; Syncope
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1409BRA002927

Write-up:This spontaneous report was received from a Physician refers to a 12 year old female patient who experienced syncope. On 29-MAR-2014, the patient was vaccinated with GARDASIL. On 29-MAR-2014 the patient experienced Syncope fifteen (15) minutes after Vaccination. The Outcome of adverse event Syncope was reported as Recovered. The relationship of Syncope with GARDASIL is Unknown. Additional information is not expected.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=542913&WAYBACKHISTORY=ON


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