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This is VAERS ID 269412

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

269412
VAERS Form:
Age:16.0
Gender:Female
Location:Florida
Vaccinated:2006-12-19
Onset:2006-12-19
Submitted:2006-12-19
Entered:2006-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0961F / 0 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE AC52B012AA / 0 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1065F / 1 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Dizziness, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: atenolol - but not taken today
Current Illness: none
Preexisting Conditions: anxiety syncope
Allergies:
Diagnostic Lab Data: Bp 117/68 HR 85 after incident
CDC 'Split Type':

Write-up:Patient felt dizzy after dTaP, Varicella, and HPV administration. She had a syncopal episode lasting seconds, immediately recoverd with stable vital signs. To note patient has a past medical history significant for syncope and did not take her atenolo t"hat morning. She was sent to the ER for fluids and further monitoring.


Changed on 12/8/2009

269412 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Florida
Vaccinated:2006-12-19
Onset:2006-12-19
Submitted:2006-12-19
Entered:2006-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. 0961F / 0 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE GLAXOSMITHKLINE BIOLOGICALS AC52B012AA / 0 LA / IM
VARCEL: VARICELLA (VARIVAX) VARICELLA (VARIVAX) / MERCK & CO. INC. 1065F / 1 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Dizziness, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: atenolol - but not taken today
Current Illness: none
Preexisting Conditions: anxiety syncope
Allergies:
Diagnostic Lab Data: Bp 117/68 HR 85 after incident
CDC 'Split Type':

Write-up:Patient felt dizzy after dTaP, Varicella, and HPV administration. She had a syncopal episode lasting seconds, immediately recoverd with stable vital signs. To note patient has a past medical history significant for syncope and did not take her atenolo t"hat that morning. She was sent to the ER for fluids and further monitoring.


Changed on 9/14/2017

269412 Before After
VAERS Form:(blank) 1
Age:16.0
Gender:Female
Location:Florida
Vaccinated:2006-12-19
Onset:2006-12-19
Submitted:2006-12-19
Entered:2006-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / 0 1 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B012AA / 0 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1065F / 1 2 RA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Dizziness, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: atenolol - but not taken today
Current Illness: none
Preexisting Conditions: anxiety syncope
Allergies:
Diagnostic Lab Data: Bp 117/68 HR 85 after incident
CDC 'Split Type':

Write-up:Patient felt dizzy after dTaP, Varicella, and HPV administration. She had a syncopal episode lasting seconds, immediately recoverd with stable vital signs. To note patient has a past medical history significant for syncope and did not take her atenolo that morning. She was sent to the ER for fluids and further monitoring.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=269412&WAYBACKHISTORY=ON


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