Personal Blog

HPV Vaccine - fainting, seizures, and other side effects

Posted by K Krasnow Waterman on Mon, Apr 07, 2008 @ 08:04 AM

April 2008

Apologies. This is a post from July 2007 that I have updated. Unfortunately, today, I made a wrong choice with the software and it is treating it as a new post. I'm hoping it doesn't break the links and subscriptions for everyone.

I have posted a new chart of all the comments received through the end of March. Click here to see it. If you want to see all the posts on HPV vaccine look at the bottom half of the far right column (it has the topics for all the blogs in this Personal Blog) and click on HPV vaccine.

I'm also adding a new request for folks who write in. I've started getting comments posted by girls and women who say they haven't had a problem or only had a little soreness from the vaccine. To those people I ask, how did you find this site? I'm really curious to find out how the word is beginning to reach people who haven't had a problem. Please share where/how did you hear that there's an issue?

Last, my condolences to Crista Valdez who wrote in a few days ago; her daughter died in her sleep last August. Our hearts go out to you.




January 2008

See my new blogs about side effects reported in Australia


the Associated Press story that says the problem is just sore arms.


NEW - December 21, 2007

I've been contacted by a reporter who would like to talk to those of you who've had or observed these side effects. His name is Tom Grant and his is editor of MetroSpirit, the alternative paper in Augusta, GA. Please contact him directly at

Also, he's sent me some information about reporting on these problems from Australia. I'll post them soon.





NEW - Sept. 16, 2007 - Let's help solve the mystery of HPV Vaccine side effects!

I've been surprised by how many of you have submitted comments and distressed by how many have suffered serious reactions. I'm not a medical scientist, but I think maybe we can use this blog to help researchers figure out what's going wrong. Based upon suggestions in the comments, I'm asking - from now on - if you're willing, when you write a comment, include the following:
your age,
your weight category (thin, medium, heavy),
anything you're allergic to (like eggs, dogs, dust, or medicines),
whether the reaction came with the 1st, 2nd or 3rd shot,
what other vaccines you had at the same time, and
the reaction you had
Most of you already include most of these things.
I promise to post another blog here with a chart that I'll keep updated and maybe we'll see a possible correlation. It should be up in about two days.


UPDATE - Sept. 30th - I've posted a separate blog entry with a chart.


Original post:

Today, I received a horrifying response to an earlier blog asking if we shouldn't know more about the long-term risks of the HPV vaccine before mandating that it be given to all young girls:

"my daughter had hpv vaccine on 6/25/07 - fainted and had two seizures immediately after injection
posted @ Tuesday, July 03, 2007 11:27 AM by kim kimes".

I immediately ran some Web searches and it turns out that Kim's daughter is not alone; there are over 1,600 adverse reaction reports. Considering the chronology I'm about to describe, it seems the word is not getting out fast enough or far enough about the risks of extremely serious side effects, including possibly death (see below). Please, if you know anyone with a daughter, make sure they're informed before they commit to having their daughter given the HPV vaccine.

1990's - first references to research and studies for an HPV vaccine.

6/27/06 - National Vaccine Information Center, a private advocacy group, recommended that the FDA not approve Gardasil as proposed. The NVIC's recommendation was largely focused on their belief that Merck's use of placebos with aluminum had caused more reactions to the placebos, thus making reactions to Gardasil less statistically notable. They also reported that during the clinical trials there were 102 serious events reported, including 17 deaths, but investigators made determinations that most were unrelated to Gardasil.

6/28/06 - FDA announced approval of Gardasil

7/14/06 - First report of an adverse reaction filed with the Vaccine Adverse Event Reporting System (VAERS), a program of the Department of Health & Human Services in which the CDC and FDA work together. On 7/11, a 14 year old girl in DC fainted and fell off the examining table after receiving the vaccine; at the emergency room, she had a headache and speech problems.

7/20/06 - Seven days after being vaccinated, a 16 year old girl developed symptoms of Guillian-Barre Syndrome, an immune disorder with weakness, tingling, and other neurological abnormalities.

Year end 2006 - After six months, there were 84 adverse reaction events related to Gardasil on VAERS The Associated Press reported that Merck had earned $235 Million on Gardasil sales in 2006.

2/21/07 - Merck was reported to have suspended its campaign to convince legislatures to mandate the vaccine.

Based upon the number of Gardasil tv commercials I've seen since then (the "One Less" advertisements), it seems that Merck continued advertising heavily to the general public.

May 2007 - Judicial Watch excerpted the VAERS database entries for Gardasil and posted them as .pdf file on the web; there were 1,637 adverse reports that seem to run through the first couple of days in May. I haven't had a chance to read it in detail but here are the incidence of some scary terms:

149 - Hospitalized
53 - Permanent Disability
239 - Syncope (loss of consciousness)
99 - Neuro (includes references to neurologist, neurological, neuro exam)
7 - Guillian-Barre

Please note that in some of the above word counts, the word is used more than once in the same report (the word death appears 5 times in total but there are 3 reported deaths). And, the issues are complex. There are unanswered questions, including those about whether it matters what other drugs the person takes regularly; whether there's a family history of drug allergies; what other vaccinations were administered at the same time; etc. I can't find the citation at the moment but did see at least one recommendation that the vaccine only be administered to people laying down because of the number of reported incidents of patients losing consciousness ("syncope"), falling, and suffering injuries.

From my perspective, the most important thing is for parents to know that these side effects have been reported and that critical questions are unanswered.

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Topics: Gardasil, hpv vaccine, technology - medicine

Associated Press not researching its stories? See today's piece on Gardasil

Posted by K Krasnow Waterman on Fri, Jan 04, 2008 @ 14:01 PM

I am astounded to see this AP article in today's news, sold to and reprinted/reposted in a ton of major media outlets today. It talks about how the HPV vaccine is just a little painful and that teens pass out from needles anyway. I'm shocked by the lack of research that clearly went into this piece and the apparent decrease in editorial oversight since the days when I was employed at a major metropolitan daily newspaper.

This website alone has lots of horrifying stories that are far worse than a little arm soreness:

My blog on reports from Australia

including reports of seizure and temporary paralysis

My chart of comments that have been posted to my blog

(though I can't keep up)

My first blog on side effects

with many comments submitted with stories.

Just today someone posted a story about his daughter developing Guillian Barre syndrome after the shot.


If you are frustrated by this information not getting out, please post this blog and anything else on topic to digg, reddit, technorati, etc.

I am sending an email to AP Medical editor now.

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Topics: Gardasil, hpv vaccine, technology - medicine

Open Letter to NY Sen Sorvino - re: hearings on mandating HPV vaccine

Posted by K Krasnow Waterman on Fri, Nov 16, 2007 @ 12:11 PM

This letter was sent by email today to the office of NY State Senator Diane Sorvino.



Dear Senator Savino -


I am writing in response to your notice regarding public hearings on the question of whether the HPV vaccine should be legislatively mandated for young girls (

I am not a medical professional. However, I am old enough to remember DES and, so, have been concerned about this issue.


I have a blog and wrote about the vaccine during the summer:

( .

I learned about the Vaccine Event Adverse Reporting System and the many reports of adverse effects from the vaccine and wrote about that:


Since then, I have been horrified by the many stories I've received from girls and their mothers about serious physical problems

(seizures, loss of consciousness, twitching, changes in menstruation, abdominal pain)

which they believe were caused by the HPV vaccine



I've started a chart to summarize them

( ),

but they come often enough that I can't keep up.


I do not know what the truth is about the vaccine and its side-effects. I ask, though, that nothing be mandated before more is known.


Thank you for your consideration,


K. Krasnow Waterman



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Topics: Gardasil, hpv vaccine, technology - medicine

HPV Vaccine - Fainting/Seizures/Side Effects Chart

Posted by K Krasnow Waterman on Sun, Sep 30, 2007 @ 19:09 PM




In reponse to many of the comments, I invite people to write in suggestions for how to get this information out. Also, please consider emailing this link to your friends, doctors, elected officials, etc.

Also, please note that much of the source material is comments to two earlier personal blogs (which are still posted at this site). The vaccine side effects reporting system, VAERS, is described in this blog.



It took longer than expected, but I've finally built a table from all the comments so far. As I've mentioned, I'm concerned about the adverse reactions to the HPV vaccine and how little is known yet. I'm hoping that gathering this information will help solve the mystery of what's causing them.

I'm not a medical researcher, so apologies if my methods are not perfect.

Since we know there are lots of folks who don't have reactions, I didn't include those in the table. The one exception to that rule is where someone wrote about siblings, in case that helps to rule out genetic predisposition.

Also, I included who wrote the comment in case they'd like to write back now and fill in the blanks.

If you've had a negative reaction or know someone who has, please submit a comment with as much of the information for the table as possible.


Age Size Known


or Other

Shot Admin.




Reaction Commenter

low blood


1st Meningitis

Hep A

TB test

10 min. Fainted snail

re: self


1st Gardasil 2 to 3 min. collapsed ... fainted ... became rigid Patricia

Doughty RN

re: daughter

"several other



5 min.

seizure... now hopitalized with slurred speech and left-side weakness Carol

re: daughter

I was healthy and athletic

up until the vaccine






8 months

have fainted 20 time since shot ... has been hospitalized ...

under the care of a cardiologist.


re: self

14 &


1st None 1 month 14-year-old had a seizure with rigid left side.

(same side as shot)


re: two



7 days fainted at home Monica Della-Quercia

re: daughter


& 16

1st Meningitis

Hep A



13 year-old: fainted....short seizure type episode...

received oxygen


re: daughters

no medical problems,

no allergies

active and healthy person

2 hours ...fainted and had a seizure.

... taken to the ER by ambulance

blood work and CT Scan ... negative.

... outpatient EEG ....abnormal


re: daughter

"dizzy rigth at first ... is normal

for me with any shot"t

1st Meningitis within

5 minutes

... dizzy ... collapsed (no loss of concious)

treated with food and drink


re: self

"dizzy rigth at first ... is normal

for me with any shot"t

3 days? severe itching ....rash on my back, leg, & arm


re: self


1st Chicken pox
... past week ....fever/nausea/daily vomiting Erin

re: friend


"a month

or two"

... abnormal menstruation ... really spotty and other symptoms Robin

re: self


4 others
.. shot area swelled ... was red and ichy for days Michele

re: daughter



... cramping of arm

later became "itchy all over" and developed yeast allergy


re: self


17 Small


90 lbs

1st &


... passed out after shots 1 & 2 Victoria

re: self

20s Small


100 lbs

passed out Victoria

re: friend


13, &






5 days

All 3: ... burning fluid with shot ... very dizzy ....

headaches through the night

Re: one 13 year-old: 5 days after ... seizure warning.

ambulance to hospital.

CT scan, chest xray, blood work, urinalysis, and MRI have all been normal


re: her

3 daughters


"horrible reaction ...

cost me so much money in travel expenses and in seeing specialists"


re: daughter


Immediate "...sudden rush or fluid.

muffled hearing and very high pitched ringing...

gray and fuzzy sight...extremely hot and went pale

... "felt like I was going to drop dead right then."



San Antonio

re; self

23 Med. never had an adverse reaction to an injection, giving blood, etc. 1st
"about a


"Fainted and fell off of the examining table" AM

re: self

21 Med. "no medical problems and no allergies" 3rd
1 hour "seizure"

hospital blood work, urinalysis, EKG, CT Scan of the head - all negative.

Follow up with neurologist. MRI which was negative.

EEG showed some abnormalities

24 hour ambulatory EEG was negative


re: daughter

"very healthy athlete who

has never had any medical issues previously"


1 1/4 hours


fell on cement pool deck, hitting head, ... bad concussion ... lost consciousness.

... ambulance to hospital

CT done, blood work done, and deemed well enough to go home.

... huge lump on her head and the whole side of her head is swollen from the fall


re: daughter

24 med "work out 4-5 days a week"

"never had a seizure before

nor do I have any known allergies

or other medical conditions"

10 min. "blacked out ...two seizures" estimated 2-3 minutes

stopped from falling off table

...hurt neck...

during seizure, arched back and flung head

gained consciousness during second seizure

...shaking, ...drooling, and loss of orientation

...clouded vision and muffled hearing

ambulance ... blood pressure ... 120/80

Kim K

re: self

none 1st

...very faint ...felt nauseated ...cold sweat ...

could barely walk. then, ... almost fainted


re: self

25 med "asthma... allergic to cats" 1st and 2nd

sore arm ...significant stomach pains day of 1st & 2nd shot. ...

...painful menstruation after 1st shot

...very early and painful, heavy menstruation after 2nd shot

vomiting and nausea the following week


re: self


10 sec. seizure

... lost bladder control ... eyes rolled back ... body rigid ... arms moving recollection of seizure

... memory of bright light approaching fast

... rushed to hospital


re: daughter


1 day

same day

interimittent, involuntary hand shaking

very sore injection arm


re: daughter

31 above


no allergies 1st none 10 min. painful ...fainted

no fainting after 2nd and 3rd shot

but, fainted again recently on a plane

Tania Lopez

re: self



fainting, dizziness, seizures, hallucinating

no memory of them

more than ten occurrences

banned from school until resolved


re: niece



fainted on my way to the reception desk.

(required to remain prone for 20 min after 2nd, and no fainting)


re: self

17 Small



menengitis, tetanus minutes collapsed

rushed to er by ambulance

3 days later suffering from severe abdomenal pain

elevated wbc count ,blood in urine ,

negative for kidney stones or appendicitis


re: daughter


26 5'8"







for mood)

many "mini-seizures"

"lots of " body jolts and unsteady movements


re: self



dizzy ... "started to twitch and jolt"


re: daughter


MMR,Meningitis shot and chicken pox

and blood draw

walked 50 feet and fainted

6 weeks later, feels run down


re: daughter




2 weeks after 1st, 2 wks of severe fatigue

2 wks after 2nd, 3 wks of severe nausea and fatigue

3 wks after 3d, fatigue, nausea, weakness, headaches, and abmonial pain (more than 6 mon to-date)

So severe, now home schooled by the school district.

Will be seeing Boston children's hospital experts


re: daughter


extreme arm soreness/pain with lifting

(2 weeks to-date)


re: self

18 athletic none 1st &


1st w/ Meningitis

2nd w/TB test

After 1st, sore joints and severe weakness for a few days

After 2nd, fainted, then vomited. Site itchy.

Weak for about 24 hours.


re: self

fainted and slept for 48 hours Lara Ward

re: daugher

very healthy, athletic,

no prior reactions to any shot

1st Meningitis Immed. fainted and seizure Kristie

re: daughter


healthy, no meds, and no known allergy

...blood pressure has changed
...Pre-vaccination: 100/60
Past 4 months: 120-130/75-85


re: self



...periods ...coming earlier ...more and more problems
...One month, in color. the hospital...fever, chills, nausea, convulsions, stomach pain, feeling faint, difficulty breathing, and headaches.
...cramps were worse than they've ever been
...tested...and...ct-scan...couldn't find anything
...developed depression...its been hell


re: self


fainted on the way to the reception desk


re: self


running every day, extremely healthy

(for 6 months to date)
blacked out and ...seizure
... experienced numbness and tingling in my arms, tachycardia (had to wear a heart monitor) and 24/7 dizziness.
MRI, EEG, EKG, urinary analysis, thyroid, ultrasounds of my heart, tilt table test and ... blood work
... doctors cannot figure out what is wrong but I strongly believe that it was the vaccine


re: self

3 to 4 weeks after appendicitis like symptoms - diagnosed as acid reflux, but much more severe... In bed for 3 weeks. Nauseated and unable to eat. Had endoscopy. Several medications. Not positive this is related to vaccine, but another young lady is experiencing the same symptoms.

Betsy Luck







After 1st shot...weakness, dizziness and sometimes tingling in arm. Also ear pain ...
After 2nd shot...dizziness and weakness is bad again.
... waiting on blood work and scheduled an MRI.

(Other reaction)





athletic, soccer player,

no medical issues


got dizzy and passed out turned blue and went into a seizure...going for EEG





right after shot
convulsing and seizuring...very rigid...lasted about 5 minutes...eyes rolled in the back of my [head],...lost control of my bladder....face turned pale white and lips turned a purple color...Smelling salts did not help..stopped breathing several different times.


re: self


diagnosed with Hashimoto thyroiditis after 1st shot; enlargement noticed during 2nd shot


re: daughter



30 days

Severe acid reflux (no prior history); persistent nausea, vomiting (some blood),diarrhea motion sickness, abdominal pain, followed by weight loss (18 lbs in 6 wks, to date), painful menstruation.
Many medical tests, all normal, but illness has not subsided. Also experieced ear pain and extreme leg soreness near in time to shot.

Crystal Wade 2 Updates re: daughter

1st& 2nd
1st w/meningitis

believe ongoing depression is correlated to first shot

Barbara re: daughter

athletic build
only allergy - long haired dogs & cats 2nd

1 day
weakness, nausea, fever and dizzyness and i am still feeling these symptoms two days after the shot Marlene re: self

very healthy; no allergies

almost fainted; great deal of pain; and had problems walking to the receptionist afterwards

(no problem w/2nd shot)

Dana re:daughter

no allergies

very sore arm (shot arm) persisted and increased more than one month as of writing; arm feels extremely weak and muscles feel all tensed up.

Legs hurt; it hurts to walk.

Diana Vo 2x

re: self


arm pain at time of shot and re-appeared 20 days later
LA re: self
tall & thin


Cried due to arm pain. Next day, fever & nausea
Carol P re: daughter
5'8" & 135


abdominal pain, backpain and extreme fatigue
Helen re:daughter
5'7" & 110


10 sec

"wicked" dizzy and had to lie down; non-stopping headache, and acheing all over.

Arm pain and aching continuing next day.

Dylan-Marie re: self
5'7" & 130
allergies: fine animal hair & dust

Severe pain in injection arm for 9 months to-date since shot. Initially couldn't lift arm above neck; 2.5 months physical therapy, shock, massage, etc. Told to expect more than 1 yr to recover

Pains in legs as well.

Bethany re: self


prior seizures


Extreme arm pain (normally no pain with shots).

Then fuzzy, dizzy, ear ringing, blacked out.

Cold sweat & "worst headache" after.

Haley re: self
on depo-prevera birth control
meningitis & MMR

Immed after 1st shot, felt very sick. problems with focusing and muscles very twitchy ever since. Often turn away from lights or screens because whole face starts twitching.

Later, after 14 months without menstruation due to birth control, menstruating 3days out of 4 for 5 weeks

Breann re: self


extreme dizzines, continuing through first day (time of writing)
Daisy re: self

1 min.
passed out onto the floor and had a seizure and urinary incontinence. Her seizure lasted about 30 sec to 1 minute. She was confused and extremely sick to her stomach when she awakened. Sheila re: daughter


few days

First, extreme leg tiredness and soreness.

Then, bad, sharp shooting pains in stomache; pains shooting down into legs & into chest.

Vision blurred .

White blood count in urine is elevated and platelet level is higher than normal.

Now has lost 20 lbs.

Had to take her out of college for at least the semester. Not showing signs of improving.

Mary Knight re: daughter

Did not have severe acne during puberty 1st

one week

Quarter size welts -- red, swollen, painful to touch -- all over face for about three weeks, and started throbbing and itching.

New welts -- smaller but more -- appeared about one week after first abated

Welts went away at about 3 months, with some scarring.

Erin re: self


shortly after
in the car "began to seize"
Jessica re: daughter


about 1 week
horrible rash of hives all over her body during the night. The hives go away during the day, but are now beginning to occur on some parts of her body before night.
Sue re: daughter

very athletic

next few weeks
Complained of severe stomach pains; diagnosed with appendicitis. Had high white blood cell count in her urine. Still complains of stomach pains when she runs or does any other activity for an extended period of time.
Cindy re: daughter
5'3" & 110

1st & 2nd

first only had a sore arm.

Then back pain and has not had a period for 2 months.

Jennifer re: daughter
5'7" & 135
no prior allergic reactions

within one minute

Became faint and dizzy. Wheelchaired to a seperate room to recover.

Whole left arm is still sore and VERY weak

Angela re: self

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Topics: Gardasil, hpv vaccine, technology - medicine

Can parents force a child to have a vaccine?

Posted by K Krasnow Waterman on Sat, Aug 18, 2007 @ 08:08 AM
Yesterday, this comment was posted to my last blog about the hpv vaccine:

"do parents have the right to decide for you whether or not you receive this vaccine? im 16."

Boy, did that send chills up my spine!  Being in disagreement with your parents on an issue that can affect your future poses hard problems.

If you can talk this out directly with your parents, that would probably be best.  Or, if you know another adult they might listen to, consider getting that person to help you.   If this becomes a legal matter, you could end up in a situation in which you have to decide between the relationship you have with your parents and what you think is best for your health. 

As a lawyer, I cannot give you specific legal advice through this blog.  But... I can give you information that may help.

1) Wherever you are, there are laws about the age of majority; the line between being a "minor" who usually can't make important decisions about herself and an adult who can.  Depending upon where you are, you might already have the legal authority to make this decision. 

2) In some places there are different ages of majority.  For example, you may be able to get married without parental consent at 16, but not able to vote until 18, and not able to drink until 21. 

3) In the US, you'll find lots more law and discussion about a minor's right to consent to medical care than the right to refuse it.  Most of the "right to consent" issues have come up in the context of contraceptives and abortions.  Try searching on a minor's right to refuse.

4) In many jurisdictions, a minor can go to court to request permission to do something that his or her parents won't allow.  This is a very serious step.  It could change the nature of your relationship with your parents forever.

You can search the web or ask a local librarian how to find information on these topics.  If none of these give you the answer you need or want, in many locations you can get free legal advice and help, sometimes called "pro bono" legal services.  You can got some information about them by searching the web or calling the bar association for your city, county, or state. 

My best advice for nearly every situation in life is to stay calm, gather as much information as you can in the time you have available, and make the best judgment you can about who has your best interests at heart.

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Topics: Gardasil, hpv vaccine, technology - medicine, public policy

More on the HPV Vaccine

Posted by K Krasnow Waterman on Fri, Mar 30, 2007 @ 02:03 AM
Although it's not my intention to become a medical blog, I see that I've had a lot of hits on this topic and so want to provide a little follow-up.

I found a discussion from The American College of Pediatricians  which is very informative.  Since it's a little long, I give the highlights from my perspective.  The Merck trials provided three immunizations over a six month period.  They involved a much larger number of young girls than I had understood (over 1100 between the ages of 9 and 15).  Antibodies to HPV peaked 7 months after treatment and then diminished, stabilizing about three years after the treatment at a level higher than before the treatment.  (However, to date, the longest follow-on study has only looked at patients four years after treatment.)

The College of Pediatricians refers to the results as "limited, short term data" and recommends:
1) that drug manufacturers establish registries of patients given the vaccine (so that long term effects can be studied)
2) that vaccine recipients be informed of that the knowledge about the vaccine's effectiveness or life span has limitations
3) that consideration be given to waiting to give the vaccine until a recipient is sexually active
4) that recipients be informed that the vaccine does not make sex "safe"

The College of Pediatricians is opposed to legislation which makes the vaccine mandatory for school attendance, noting that the disease can only be spread through "penetrating vaginal intercourse."  The College is also concerned about the ethical dilemma of having to explain sexual conduct to a nine year-old (required before administering the drug), when the child's parents may not have yet introduced the subject (since most 9 year olds in the US are not sexually active and have not reached puberty).
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Topics: Gardasil, hpv vaccine, technology - medicine, public policy

What are the Long-term Effects of HPV Vaccine?

Posted by K Krasnow Waterman on Fri, Mar 02, 2007 @ 12:03 PM
I am astounded by the speed at which discussion about the HPV Vaccine is truning to mandatory vaccination.  I want to remind as many people as possible about DES (Di-Ethyl-Stilbestrol), a drug that was used for decades before its side effects were known.  Only when the daughters of the drug-takers themselves matured, did the full range of problems become apparent. 

I've only done a litte reading on this new HPV Vaccine, but so far have seen no references to multi-decade or multi-generational study and very little reference to studies in young girls (the targets of proposed legislation).  I found published references only dating back to the mid-90's (see the end of this CDC webpage).  And, although, this is not my professional area of expertise I do know drug manufacturers generally have three phases of testing.  For Merck (manufacturer of Gardasil),  I found references to three studies -- an article (see first paragraph) that describes a study on less than 300 women in Brazil over a three year period; another article describing a study on over 5,000 women for approximately 17 months; and one reference to a study that included girls aged 10-15 - there may have been only 158 girls in the study - that lasted six months.  For GlaxoKlineSmith (manufacturer of Cervarix), I found a report of a one year study that does not indicate that young girls were included;

I'm not saying that this vaccine won't turn out to be wonderful.  I'm asking whether we've studied this drug long enough to be so confident about long-term effects that we are willing to mandate the taking of the drug by our entire population of young women? 

If you know more about the drug, the length of drug studies, etc., please post a comment here.
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Topics: Gardasil, hpv vaccine, technology - medicine, public policy