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This is VAERS ID 655398

History of Changes from the VAERS Wayback Machine

First Appeared on 10/14/2016

655398
VAERS Form:
Age:12.0
Gender:Male
Location:California
Vaccinated:2016-09-23
Onset:2016-09-23
Submitted:2016-09-26
Entered:2016-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. M021407 / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Fall, Head injury, Loss of consciousness, Skull fracture, Computerised tomogram head abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Back injury x 1 week
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CT head-fracture through occipital bone fracture through temporal bone
CDC 'Split Type':

Write-up:Given HPV #2 at 943am. Asked if had any problems with 1st HPV, denied. Sent to another clinic 10 min away to scoliosis series felt dizzy in xray room, fell and hit head. Unconscious, suffered skull fracture.


Changed on 12/14/2016

655398 Before After
VAERS Form:
Age:12.0
Gender:Male
Location:California
Vaccinated:2016-09-23 2016-09-12
Onset:2016-09-23 2016-09-12
Submitted:2016-09-26
Entered:2016-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. M021407 / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Fall, Head injury, Loss of consciousness, Skull fracture, Computerised tomogram head abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: (blank) 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Back injury x 1 week
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CT head-fracture through occipital bone fracture through temporal bone
CDC 'Split Type':

Write-up:Given HPV #2 at 943am. Asked if had any problems with 1st HPV, denied. Sent to another clinic 10 min away to scoliosis series felt dizzy in xray room, fell and hit head. Unconscious, suffered skull fracture.


Changed on 9/14/2017

655398 Before After
VAERS Form:(blank) 1
Age:12.0
Gender:Male
Location:California
Vaccinated:2016-09-12
Onset:2016-09-12
Submitted:2016-09-26
Entered:2016-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. M021407 / 1 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Fall, Head injury, Loss of consciousness, Skull fracture, Computerised tomogram head abnormal

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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: Back injury x 1 week
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CT head-fracture through occipital bone fracture through temporal bone
CDC 'Split Type':

Write-up:Given HPV #2 at 943am. Asked if had any problems with 1st HPV, denied. Sent to another clinic 10 min away to scoliosis series felt dizzy in xray room, fell and hit head. Unconscious, suffered skull fracture.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=655398&WAYBACKHISTORY=ON


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