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This is VAERS ID 272276

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

272276
VAERS Form:
Age:12.0
Gender:Female
Location:New Hampshire
Vaccinated:2006-12-08
Onset:2006-12-08
Submitted:2007-02-14
Entered:2007-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0954F / 0 UN / -
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR - / 0 UN / -
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / -

Administered by: Private      Purchased by: Unknown
Symptoms: Fall, Feeling abnormal, Headache, Injury

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:
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up:Information has been received from a physician concerning a 12 year old female with no illness at the time of vaccination who on 08-DEC-2006 was vaccinated with a 0.5 ml first dose of Gardasil (yeast) (lot 653938/0954F). On 08-DEC-2006, the patient was co"ncomitantly vaccinated with a first dose of Menatra, a dose of influenza virus vaccine (unspecified) and a dose of Boostrix. On 08-Dec-2006, the patient fainted shortly after vaccination. She fell from a standing position and hit the back of head on the f


Changed on 12/8/2009

272276 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:New Hampshire
Vaccinated:2006-12-08
Onset:2006-12-08
Submitted:2007-02-14
Entered:2007-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (NO BRAND NAME) INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0954F / 0 UN / -
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR - / 0 UN / -
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Fall, Feeling abnormal, Headache, Injury, Loss of consciousness, Pallor, 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:
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': (blank) WAES0701USA00266

Write-up:Information has been received from a physician concerning a 12 year old female with no illness at the time of vaccination who on 08-DEC-2006 was vaccinated with a 0.5 ml first dose of Gardasil (yeast) (lot 653938/0954F). On 08-DEC-2006, the patient was co"ncomitantly concomitantly vaccinated with a first dose of Menatra, a dose of influenza virus vaccine (unspecified) and a dose of Boostrix. On 08-Dec-2006, the patient fainted shortly after vaccination. She fell from a standing position and hit the back of head on the f floor. She was unconscious for approximately 30 seconds,a and then was dazed and pale. The patient was "ok" after a few minutes. The patient complained of a headache, frontal to occipital. The patient was "ok" at home later that evening. The patient recovered with no sequalae on 08-DEC-2006. Additional information is not expected.


Changed on 4/7/2010

272276 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:New Hampshire
Vaccinated:2006-12-08
Onset:2006-12-08
Submitted:2007-02-14
Entered:2007-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0954F / 0 UN / -
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR - / 0 UN / -
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / -

Administered by: Private      Purchased by: Private
Symptoms: Fall, Feeling abnormal, Headache, Injury, Loss of consciousness, Pallor, 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:
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0701USA00266

Write-up:Information has been received from a physician concerning a 12 year old female with no illness at the time of vaccination who on 08-DEC-2006 was vaccinated with a 0.5 ml first dose of Gardasil (yeast) (lot 653938/0954F). On 08-DEC-2006, the patient was concomitantly vaccinated with a first dose of Menatra, a dose of influenza virus vaccine (unspecified) and a dose of Boostrix. On 08-Dec-2006, the patient fainted shortly after vaccination. She fell from a standing position and hit the back of head on the floor. She was unconscious for approximately 30 seconds,a and then was dazed and pale. The patient was "ok" after a few minutes. The patient complained of a headache, frontal to occipital. The patient was "ok" at home later that evening. The patient recovered with no sequalae on 08-DEC-2006. Additional information is not expected.


Changed on 7/7/2013

272276 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:New Hampshire
Vaccinated:2006-12-08
Onset:2006-12-08
Submitted:2007-02-14
Entered:2007-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0954F / 0 UN / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR - / 0 UN / -
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / -

Administered by: Private      Purchased by: Private
Symptoms: Fall, Feeling abnormal, Headache, Injury, Loss of consciousness, Pallor, 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:
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0701USA00266

Write-up:Information has been received from a physician concerning a 12 year old female with no illness at the time of vaccination who on 08-DEC-2006 was vaccinated with a 0.5 ml first dose of Gardasil (yeast) (lot 653938/0954F). On 08-DEC-2006, the patient was concomitantly vaccinated with a first dose of Menatra, a dose of influenza virus vaccine (unspecified) and a dose of Boostrix. On 08-Dec-2006, the patient fainted shortly after vaccination. She fell from a standing position and hit the back of head on the floor. She was unconscious for approximately 30 seconds,a and then was dazed and pale. The patient was "ok" after a few minutes. The patient complained of a headache, frontal to occipital. The patient was "ok" at home later that evening. The patient recovered with no sequalae on 08-DEC-2006. Additional information is not expected.


Changed on 12/14/2016

272276 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:New Hampshire
Vaccinated:2006-12-08
Onset:2006-12-08
Submitted:2007-02-14
Entered:2007-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0954F / 0 UN / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR - / 0 UN / -
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / -

Administered by: Private      Purchased by: Private
Symptoms: Fall, Feeling abnormal, Headache, Injury, Loss of consciousness, Pallor, 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:
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0701USA00266

Write-up:Information has been received from a physician concerning a 12 year old female with no illness at the time of vaccination who on 08-DEC-2006 was vaccinated with a 0.5 ml first dose of Gardasil (yeast) (lot 653938/0954F). On 08-DEC-2006, the patient was concomitantly vaccinated with a first dose of Menatra, a dose of influenza virus vaccine (unspecified) and a dose of Boostrix. On 08-Dec-2006, the patient fainted shortly after vaccination. She fell from a standing position and hit the back of head on the floor. She was unconscious for approximately 30 seconds,a and then was dazed and pale. The patient was "ok" after a few minutes. The patient complained of a headache, frontal to occipital. The patient was "ok" at home later that evening. The patient recovered with no sequalae on 08-DEC-2006. Additional information is not expected.


Changed on 5/14/2017

272276 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:New Hampshire
Vaccinated:2006-12-08
Onset:2006-12-08
Submitted:2007-02-14
Entered:2007-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0954F / 0 UN / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR - / 0 UN / -
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / -

Administered by: Private      Purchased by: Private
Symptoms: Fall, Feeling abnormal, Headache, Injury, Loss of consciousness, Pallor, 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:
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0701USA00266

Write-up:Information has been received from a physician concerning a 12 year old female with no illness at the time of vaccination who on 08-DEC-2006 was vaccinated with a 0.5 ml first dose of Gardasil (yeast) (lot 653938/0954F). On 08-DEC-2006, the patient was concomitantly vaccinated with a first dose of Menatra, a dose of influenza virus vaccine (unspecified) and a dose of Boostrix. On 08-Dec-2006, the patient fainted shortly after vaccination. She fell from a standing position and hit the back of head on the floor. She was unconscious for approximately 30 seconds,a and then was dazed and pale. The patient was "ok" after a few minutes. The patient complained of a headache, frontal to occipital. The patient was "ok" at home later that evening. The patient recovered with no sequalae on 08-DEC-2006. Additional information is not expected.


Changed on 9/14/2017

272276 Before After
VAERS Form:(blank) 1
Age:12.0
Gender:Female
Location:New Hampshire
Vaccinated:2006-12-08
Onset:2006-12-08
Submitted:2007-02-14
Entered:2007-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0954F / 0 1 UN / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / 0 1 UN / -
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UNK UN / -

Administered by: Private      Purchased by: Private
Symptoms: Fall, Feeling abnormal, Headache, Injury, Loss of consciousness, Pallor, 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:
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0701USA00266

Write-up:Information has been received from a physician concerning a 12 year old female with no illness at the time of vaccination who on 08-DEC-2006 was vaccinated with a 0.5 ml first dose of Gardasil (yeast) (lot 653938/0954F). On 08-DEC-2006, the patient was concomitantly vaccinated with a first dose of Menatra, a dose of influenza virus vaccine (unspecified) and a dose of Boostrix. On 08-Dec-2006, the patient fainted shortly after vaccination. She fell from a standing position and hit the back of head on the floor. She was unconscious for approximately 30 seconds,a and then was dazed and pale. The patient was "ok" after a few minutes. The patient complained of a headache, frontal to occipital. The patient was "ok" at home later that evening. The patient recovered with no sequalae on 08-DEC-2006. Additional information is not expected.


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