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This is VAERS ID 274084

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

274084
VAERS Form:
Age:13.0
Gender:Female
Location:Florida
Vaccinated:2007-02-19
Onset:2007-02-19
Submitted:2007-03-11
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - - / -
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR - / - - / -
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Laceration, Oxygen saturation, Syncope, Tooth repair

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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: PO2 99%
CDC 'Split Type':

Write-up:2-19-07 child had well check up, received vaccines of Gardasil, Hep A, Menactra, Varicella. Approx at 3:00pm had syncopal episode on the way out of the office. First aid rendered for lip laceration. B/P and vital signs checked, reverse trendelenburg posit"ion. Sent to dental office for tooth repair.


Changed on 12/8/2009

274084 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Florida
Vaccinated:2007-02-19
Onset:2007-02-19
Submitted:2007-03-11
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - - / -
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR - / - - / -
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Laceration, Oxygen saturation, Syncope, Tooth repair

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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: PO2 99%
CDC 'Split Type':

Write-up:2-19-07 child had well check up, received vaccines of Gardasil, Hep A, Menactra, Varicella. Approx at 3:00pm had syncopal episode on the way out of the office. First aid rendered for lip laceration. B/P and vital signs checked, reverse trendelenburg posit"ion. position. Sent to dental office for tooth repair.


Changed on 3/2/2010

274084 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Florida
Vaccinated:2007-02-19
Onset:2007-02-19
Submitted:2007-03-11
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) HEP A (HAVRIX) / UNKNOWN MANUFACTURER GLAXOSMITHKLINE BIOLOGICALS - AHAVB19AA / - - UN / - UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - 001N / - - UN / - UN
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR - U1968AA / - - UN / - UN
VARCEL: VARICELLA (NO BRAND NAME) VARICELLA (VARIVAX) / UNKNOWN MANUFACTURER MERCK & CO. INC. - 1497F / - - UN / - UN

Administered by: Private      Purchased by: Private
Symptoms: Laceration, Oxygen saturation, Syncope, Tooth repair

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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: PO2 99%
CDC 'Split Type':

Write-up:2-19-07 child had well check up, received vaccines of Gardasil, Hep A, Menactra, Varicella. Approx at 3:00pm had syncopal episode on the way out of the office. First aid rendered for lip laceration. B/P and vital signs checked, reverse trendelenburg position. Sent to dental office for tooth repair.


Changed on 4/7/2010

274084 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Florida
Vaccinated:2007-02-19
Onset:2007-02-19
Submitted:2007-03-11
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB19AA / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 001N / - UN / UN
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1968AA / - UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1497F / - UN / UN

Administered by: Private      Purchased by: Private
Symptoms: Laceration, Oxygen saturation, Syncope, Tooth repair

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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: PO2 99%
CDC 'Split Type':

Write-up:2-19-07 child had well check up, received vaccines of Gardasil, Hep A, Menactra, Varicella. Approx at 3:00pm had syncopal episode on the way out of the office. First aid rendered for lip laceration. B/P and vital signs checked, reverse trendelenburg position. Sent to dental office for tooth repair.


Changed on 6/14/2014

274084 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Florida
Vaccinated:2007-02-19
Onset:2007-02-19
Submitted:2007-03-11
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB19AA / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 001N / - UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1968AA / - UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1497F / - UN / UN

Administered by: Private      Purchased by: Private
Symptoms: Laceration, Oxygen saturation, Syncope, Tooth repair

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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: PO2 99%
CDC 'Split Type':

Write-up:2-19-07 child had well check up, received vaccines of Gardasil, Hep A, Menactra, Varicella. Approx at 3:00pm had syncopal episode on the way out of the office. First aid rendered for lip laceration. B/P and vital signs checked, reverse trendelenburg position. Sent to dental office for tooth repair.


Changed on 5/14/2017

274084 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Florida
Vaccinated:2007-02-19
Onset:2007-02-19
Submitted:2007-03-11
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB19AA / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 001N / - UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1968AA / - UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1497F / - UN / UN

Administered by: Private      Purchased by: Private
Symptoms: Laceration, Oxygen saturation, Syncope, Tooth repair

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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: PO2 99%
CDC 'Split Type':

Write-up:2-19-07 child had well check up, received vaccines of Gardasil, Hep A, Menactra, Varicella. Approx at 3:00pm had syncopal episode on the way out of the office. First aid rendered for lip laceration. B/P and vital signs checked, reverse trendelenburg position. Sent to dental office for tooth repair.


Changed on 9/14/2017

274084 Before After
VAERS Form:(blank) 1
Age:13.0
Gender:Female
Location:Florida
Vaccinated:2007-02-19
Onset:2007-02-19
Submitted:2007-03-11
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB19AA / - UNK UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 001N / - UNK UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1968AA / - UNK UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1497F / - UNK UN / UN

Administered by: Private      Purchased by: Private
Symptoms: Laceration, Oxygen saturation, Syncope, Tooth repair

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: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: PO2 99%
CDC 'Split Type':

Write-up:2-19-07 child had well check up, received vaccines of Gardasil, Hep A, Menactra, Varicella. Approx at 3:00pm had syncopal episode on the way out of the office. First aid rendered for lip laceration. B/P and vital signs checked, reverse trendelenburg position. Sent to dental office for tooth repair.


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