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This is VAERS ID 266581

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

266581
VAERS Form:
Age:19.0
Gender:Female
Location:Virginia
Vaccinated:2006-10-13
Onset:2006-10-13
Submitted:2006-11-08
Entered:2006-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUZONE) / AVENTIS PASTEUR, INC. U2165CA / 2 RA / IM
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0688F / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Blood pressure decreased, Bradycardia, Heart rate irregular

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations: Fever~DTP (unknown mfr)~1~1~In Patient
Other Medications: Allegra, Nasolcrom, Acne meds, Bactrim
Current Illness: NONE
Preexisting Conditions: Acne, allergies to raw peaches, carrot, potatoes, kiwi, apples, cherries.
Allergies:
Diagnostic Lab Data: Skin prick tested for allergies.
CDC 'Split Type': Acne, allergies to raw peaches, carrot, potatoes, kiwi, apples, cherries.

Write-up:Vasovagal RXN. Pt HR decreased to 50 and BP decreased.


Changed on 12/8/2009

266581 Before After
VAERS Form:
Age:19.0
Gender:Female
Location:Virginia
Vaccinated:2006-10-13
Onset:2006-10-13
Submitted:2006-11-08
Entered:2006-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUZONE) INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR, INC. AVENTIS PASTEUR U2165CA / 2 RA / IM
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. 0688F / 0 LA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Blood pressure decreased, Bradycardia, Heart rate irregular

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations: Fever~DTP (unknown mfr)~1~1~In Patient
Other Medications: Allegra, Nasolcrom, Acne meds, Bactrim
Current Illness: NONE
Preexisting Conditions: Acne, allergies to raw peaches, carrot, potatoes, kiwi, apples, cherries.
Allergies:
Diagnostic Lab Data: Skin prick tested for allergies.
CDC 'Split Type': Acne, allergies to raw peaches, carrot, potatoes, kiwi, apples, cherries. (blank)

Write-up:Vasovagal RXN. Pt HR decreased to 50 and BP decreased.


Changed on 7/7/2013

266581 Before After
VAERS Form:
Age:19.0
Gender:Female
Location:Virginia
Vaccinated:2006-10-13
Onset:2006-10-13
Submitted:2006-11-08
Entered:2006-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U2165CA / 2 RA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U2165CA / 2 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0688F / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Blood pressure decreased, Bradycardia, Heart rate irregular

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations: Fever~DTP (unknown mfr)~1~1~In Patient
Other Medications: Allegra, Nasolcrom, Acne meds, Bactrim
Current Illness: NONE
Preexisting Conditions: Acne, allergies to raw peaches, carrot, potatoes, kiwi, apples, cherries.
Allergies:
Diagnostic Lab Data: Skin prick tested for allergies.
CDC 'Split Type':

Write-up:Vasovagal RXN. Pt HR decreased to 50 and BP decreased.


Changed on 5/14/2017

266581 Before After
VAERS Form:
Age:19.0
Gender:Female
Location:Virginia
Vaccinated:2006-10-13
Onset:2006-10-13
Submitted:2006-11-08
Entered:2006-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR SANOFI PASTEUR U2165CA / 2 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0688F / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Blood pressure decreased, Bradycardia, Heart rate irregular

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations: Fever~DTP (unknown mfr)~1~1~In (no brand name)~1~1.17~In Patient
Other Medications: Allegra, Nasolcrom, Acne meds, Bactrim
Current Illness: NONE
Preexisting Conditions: Acne, allergies to raw peaches, carrot, potatoes, kiwi, apples, cherries.
Allergies:
Diagnostic Lab Data: Skin prick tested for allergies.
CDC 'Split Type':

Write-up:Vasovagal RXN. Pt HR decreased to 50 and BP decreased.


Changed on 9/14/2017

266581 Before After
VAERS Form:(blank) 1
Age:19.0
Gender:Female
Location:Virginia
Vaccinated:2006-10-13
Onset:2006-10-13
Submitted:2006-11-08
Entered:2006-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2165CA / 2 3 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0688F / 0 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Blood pressure decreased, Bradycardia, Heart rate irregular

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations: Fever~DTP (no brand name)~1~1.17~In Patient
Other Medications: Allegra, Nasolcrom, Acne meds, Bactrim
Current Illness: NONE
Preexisting Conditions: Acne, allergies to raw peaches, carrot, potatoes, kiwi, apples, cherries.
Allergies:
Diagnostic Lab Data: Skin prick tested for allergies.
CDC 'Split Type':

Write-up:Vasovagal RXN. Pt HR decreased to 50 and BP decreased.


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