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This is VAERS ID 266889

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

266889
VAERS Form:
Age:14.0
Gender:Female
Location:Michigan
Vaccinated:2006-10-25
Onset:2006-10-26
Submitted:2006-11-16
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUZONE) / AVENTIS PASTEUR, INC. U2256AA / - UN / IM
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0955F / 0 UN / IM
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, INC. U1948AA / 0 UN / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE AC52B012AA / 0 UN / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Dehydration, Hypersensitivity, Muscle spasms, Pyrexia

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nasocort, Zyrtec, Allergy injections.
Current Illness:
Preexisting Conditions: Allergic Rhinitis.
Allergies:
Diagnostic Lab Data: Labs: Glucose 118, CO2 21, C-reactive protein 1.8.
CDC 'Split Type':

Write-up:Pt received injections 10/25/06. Flu and HPV in one thigh. Tdap and Menactra in other thigh unk which thigh each given. Pt then went to allergist and received allergy injection in each arm. Admitted 10/26/06 for fever 103, dehydration and muscle cramping,"sent home 10/27/06.


Changed on 12/8/2009

266889 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Michigan
Vaccinated:2006-10-25
Onset:2006-10-26
Submitted:2006-11-16
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUZONE) INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR, INC. AVENTIS PASTEUR U2256AA / - UN / IM
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. 0955F / 0 UN / IM
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, INC. AVENTIS PASTEUR U1948AA / 0 UN / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE GLAXOSMITHKLINE BIOLOGICALS AC52B012AA / 0 UN / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Dehydration, Hypersensitivity, Muscle spasms, Pyrexia

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nasocort, Zyrtec, Allergy injections.
Current Illness:
Preexisting Conditions: Allergic Rhinitis. PMH: environmental allergens. Eczema. Roavirus at age 2 months.
Allergies:
Diagnostic Lab Data: Labs: Glucose 118, CO2 21, C-reactive protein 1.8.
CDC 'Split Type':

Write-up:Pt received injections 10/25/06. Flu and HPV in one thigh. Tdap and Menactra in other thigh unk which thigh each given. Pt then went to allergist and received allergy injection in each arm. Admitted 10/26/06 for fever 103, dehydration and muscle cramping,"sent cramping, sent home 10/27/06. DC DX: allergic reaction. 2 day history of fever. On same day as immunizations she received routine allergy shots. Immunizations received in thighs and allergy injections in arms. Complained of arms puffed and welted evening prior to admission, became painful. Also blotchiness on legs. Complained of pain in legs. Headache since immunizations, myalgias and arthralgias especially to shoulder area. Neck pain, prickly sensaton in feet. Previous immunization reacion 3 weeks ago with pain and symptomatic problems. PMH: environmental allergens. Eczema. Roavirus at age 2 months. PE: Extremities, there is injection site visible. No rash, erythema or exudate noted around the injection sites. No other rashes.


Changed on 4/7/2010

266889 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Michigan
Vaccinated:2006-10-25
Onset:2006-10-26
Submitted:2006-11-16
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U2256AA / - UN / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 0 UN / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U1948AA / 0 UN / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B012AA / 0 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Dehydration, Hypersensitivity, Muscle spasms, Pyrexia

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nasocort, Zyrtec, Allergy injections.
Current Illness:
Preexisting Conditions: Allergic Rhinitis. PMH: environmental allergens. Eczema. Roavirus at age 2 months.
Allergies:
Diagnostic Lab Data: Labs: Glucose 118, CO2 21, C-reactive protein 1.8.
CDC 'Split Type':

Write-up:Pt received injections 10/25/06. Flu and HPV in one thigh. Tdap and Menactra in other thigh unk which thigh each given. Pt then went to allergist and received allergy injection in each arm. Admitted 10/26/06 for fever 103, dehydration and muscle cramping, sent home 10/27/06. DC DX: allergic reaction. 2 day history of fever. On same day as immunizations she received routine allergy shots. Immunizations received in thighs and allergy injections in arms. Complained of arms puffed and welted evening prior to admission, became painful. Also blotchiness on legs. Complained of pain in legs. Headache since immunizations, myalgias and arthralgias especially to shoulder area. Neck pain, prickly sensaton in feet. Previous immunization reacion 3 weeks ago with pain and symptomatic problems. PMH: environmental allergens. Eczema. Roavirus at age 2 months. PE: Extremities, there is injection site visible. No rash, erythema or exudate noted around the injection sites. No other rashes.


Changed on 7/7/2013

266889 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Michigan
Vaccinated:2006-10-25
Onset:2006-10-26
Submitted:2006-11-16
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U2256AA / - UN / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U2256AA / - UN / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 0 UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U1948AA / 0 UN / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B012AA / 0 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Dehydration, Hypersensitivity, Muscle spasms, Pyrexia

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nasocort, Zyrtec, Allergy injections.
Current Illness:
Preexisting Conditions: Allergic Rhinitis. PMH: environmental allergens. Eczema. Roavirus at age 2 months.
Allergies:
Diagnostic Lab Data: Labs: Glucose 118, CO2 21, C-reactive protein 1.8.
CDC 'Split Type':

Write-up:Pt received injections 10/25/06. Flu and HPV in one thigh. Tdap and Menactra in other thigh unk which thigh each given. Pt then went to allergist and received allergy injection in each arm. Admitted 10/26/06 for fever 103, dehydration and muscle cramping, sent home 10/27/06. DC DX: allergic reaction. 2 day history of fever. On same day as immunizations she received routine allergy shots. Immunizations received in thighs and allergy injections in arms. Complained of arms puffed and welted evening prior to admission, became painful. Also blotchiness on legs. Complained of pain in legs. Headache since immunizations, myalgias and arthralgias especially to shoulder area. Neck pain, prickly sensaton in feet. Previous immunization reacion 3 weeks ago with pain and symptomatic problems. PMH: environmental allergens. Eczema. Roavirus at age 2 months. PE: Extremities, there is injection site visible. No rash, erythema or exudate noted around the injection sites. No other rashes.


Changed on 5/14/2017

266889 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Michigan
Vaccinated:2006-10-25
Onset:2006-10-26
Submitted:2006-11-16
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR SANOFI PASTEUR U2256AA / - UN / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 0 UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U1948AA / 0 UN / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B012AA / 0 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Dehydration, Hypersensitivity, Muscle spasms, Pyrexia

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nasocort, Zyrtec, Allergy injections.
Current Illness:
Preexisting Conditions: Allergic Rhinitis. PMH: environmental allergens. Eczema. Roavirus at age 2 months.
Allergies:
Diagnostic Lab Data: Labs: Glucose 118, CO2 21, C-reactive protein 1.8.
CDC 'Split Type':

Write-up:Pt received injections 10/25/06. Flu and HPV in one thigh. Tdap and Menactra in other thigh unk which thigh each given. Pt then went to allergist and received allergy injection in each arm. Admitted 10/26/06 for fever 103, dehydration and muscle cramping, sent home 10/27/06. DC DX: allergic reaction. 2 day history of fever. On same day as immunizations she received routine allergy shots. Immunizations received in thighs and allergy injections in arms. Complained of arms puffed and welted evening prior to admission, became painful. Also blotchiness on legs. Complained of pain in legs. Headache since immunizations, myalgias and arthralgias especially to shoulder area. Neck pain, prickly sensaton in feet. Previous immunization reacion 3 weeks ago with pain and symptomatic problems. PMH: environmental allergens. Eczema. Roavirus at age 2 months. PE: Extremities, there is injection site visible. No rash, erythema or exudate noted around the injection sites. No other rashes.


Changed on 9/14/2017

266889 Before After
VAERS Form:(blank) 1
Age:14.0
Gender:Female
Location:Michigan
Vaccinated:2006-10-25
Onset:2006-10-26
Submitted:2006-11-16
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2256AA / - UNK UN / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 0 1 UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1948AA / 0 1 UN / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B012AA / 0 1 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Dehydration, Hypersensitivity, Muscle spasms, Pyrexia

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Nasocort, Zyrtec, Allergy injections.
Current Illness:
Preexisting Conditions: Allergic Rhinitis. PMH: environmental allergens. Eczema. Roavirus at age 2 months.
Allergies:
Diagnostic Lab Data: Labs: Glucose 118, CO2 21, C-reactive protein 1.8.
CDC 'Split Type':

Write-up:Pt received injections 10/25/06. Flu and HPV in one thigh. Tdap and Menactra in other thigh unk which thigh each given. Pt then went to allergist and received allergy injection in each arm. Admitted 10/26/06 for fever 103, dehydration and muscle cramping, sent home 10/27/06. DC DX: allergic reaction. 2 day history of fever. On same day as immunizations she received routine allergy shots. Immunizations received in thighs and allergy injections in arms. Complained of arms puffed and welted evening prior to admission, became painful. Also blotchiness on legs. Complained of pain in legs. Headache since immunizations, myalgias and arthralgias especially to shoulder area. Neck pain, prickly sensaton in feet. Previous immunization reacion 3 weeks ago with pain and symptomatic problems. PMH: environmental allergens. Eczema. Roavirus at age 2 months. PE: Extremities, there is injection site visible. No rash, erythema or exudate noted around the injection sites. No other rashes.


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