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This is VAERS ID 273789

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

273789
VAERS Form:
Age:17.0
Gender:Female
Location:Michigan
Vaccinated:2007-03-09
Onset:2007-03-10
Submitted:2007-03-12
Entered:2007-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 00130 / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR U1968AA / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Body temperature increased, Chills

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: Prevacid 30mg Q day / Allegra
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Elevated temp and chills approx. 16 hours after vaccine given


Changed on 12/8/2009

273789 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Michigan
Vaccinated:2007-03-09
Onset:2007-03-10
Submitted:2007-03-12
Entered:2007-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 00130 / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR U1968AA / 0 LA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Body temperature increased, Chills

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: Prevacid 30mg Q day / Allegra
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Elevated temp and chills approx. 16 hours after vaccine given


Changed on 4/7/2010

273789 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Michigan
Vaccinated:2007-03-09
Onset:2007-03-10
Submitted:2007-03-12
Entered:2007-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 00130 / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U1968AA / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Body temperature increased, Chills

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: Prevacid 30mg Q day / Allegra
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Elevated temp and chills approx. 16 hours after vaccine given


Changed on 5/14/2017

273789 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Michigan
Vaccinated:2007-03-09
Onset:2007-03-10
Submitted:2007-03-12
Entered:2007-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 00130 / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U1968AA / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Body temperature increased, Chills

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: Prevacid 30mg Q day / Allegra
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Elevated temp and chills approx. 16 hours after vaccine given


Changed on 9/14/2017

273789 Before After
VAERS Form:(blank) 1
Age:17.0
Gender:Female
Location:Michigan
Vaccinated:2007-03-09
Onset:2007-03-10
Submitted:2007-03-12
Entered:2007-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 00130 / 0 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1968AA / 0 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Body temperature increased, Chills

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: Prevacid 30mg Q day / Allegra
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Elevated temp and chills approx. 16 hours after vaccine given


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