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This is VAERS ID 274470

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

274470
VAERS Form:
Age:12.0
Gender:Female
Location:New York
Vaccinated:2007-03-13
Onset:2007-03-13
Submitted:2007-03-15
Entered:2007-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0186U / 0 LA / -
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR U1967AA / 0 RA / -
TDAP: TDAP (ADACEL) / AVENTIS PASTEUR C2456AA / 5 RA / -

Administered by: Private      Purchased by: Unknown
Symptoms: Chest discomfort, Neck pain, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Severe arm and neck pain, chest tightness, 2 hour post vaccine. No prior history of asthma, abdominal pain. Seen in the ER and discharged with Albuterol.


Changed on 12/8/2009

274470 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:New York
Vaccinated:2007-03-13
Onset:2007-03-13
Submitted:2007-03-15
Entered:2007-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0186U / 0 LA / -
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR U1967AA / 0 RA / -
TDAP: TDAP (ADACEL) / AVENTIS PASTEUR C2456AA / 5 RA / -

Administered by: Private      Purchased by: Unknown Other
Symptoms: Chest discomfort, Neck pain, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Severe arm and neck pain, chest tightness, 2 hour post vaccine. No prior history of asthma, abdominal pain. Seen in the ER and discharged with Albuterol.


Changed on 3/2/2010

274470 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:New York
Vaccinated:2007-03-13
Onset:2007-03-13
Submitted:2007-03-15
Entered:2007-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0186U / 0 LA / - IM
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U1967AA / 0 RA / - UN
TDAP: TDAP (ADACEL) / AVENTIS PASTEUR SANOFI PASTEUR C2456AA / 5 4 RA / - UN

Administered by: Private      Purchased by: Other
Symptoms: Chest discomfort, Neck pain, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: NONE None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Chest X-ray, 03/13?/07
CDC 'Split Type':

Write-up:Severe arm and neck pain, chest tightness, 2 hour post vaccine. No prior history of asthma, abdominal pain. Seen in the ER and discharged with Albuterol. This is in follow-up to report(s) previously submitted on 4/13/2007. Information has been received from a registered nurse and a licensed practical nurse concerning a 12 year old female student with no pertinent medical history who on 13-MAR-2007, at 16:45 was vaccinated, intramuscularly into the left arm, with a 0.5 mlm first dose of GARDASIL (lot #655618/0186U) concomitantly with a first dose of MENACTRA (lot #0167AA) and a fifth dose of ADACEL (lot #C2456AA) into the right arm. On 13-MAR-2007, at 17:45 (also, reported as 2 hours after vaccination), the patient developed severe arm and neck pain, chest tightness and abdominal pain. At bedtime, the patient had difficulty breathing and pain in her chest. Her mother took her to the emergency room where she had a chest x-ray. It was reported that there was no detection of wheezing, swelling or pulmonary embolism. She was treated with albuterol which "did not seem to help." As of 14-MAR-2007, the patient was improving her arm and chest were "just sore." No further information is available.


Changed on 4/7/2010

274470 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:New York
Vaccinated:2007-03-13
Onset:2007-03-13
Submitted:2007-03-15
Entered:2007-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0186U / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1967AA / 0 RA / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2456AA / 4 RA / UN

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain, Abdominal pain upper, Chest discomfort, Chest pain, Chest X-ray, Dyspnoea, Neck pain, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Chest X-ray, 03/13?/07
CDC 'Split Type':

Write-up:Severe arm and neck pain, chest tightness, 2 hour post vaccine. No prior history of asthma, abdominal pain. Seen in the ER and discharged with Albuterol. This is in follow-up to report(s) previously submitted on 4/13/2007. Information has been received from a registered nurse and a licensed practical nurse concerning a 12 year old female student with no pertinent medical history who on 13-MAR-2007, at 16:45 was vaccinated, intramuscularly into the left arm, with a 0.5 mlm first dose of GARDASIL (lot #655618/0186U) concomitantly with a first dose of MENACTRA (lot #0167AA) and a fifth dose of ADACEL (lot #C2456AA) into the right arm. On 13-MAR-2007, at 17:45 (also, reported as 2 hours after vaccination), the patient developed severe arm and neck pain, chest tightness and abdominal pain. At bedtime, the patient had difficulty breathing and pain in her chest. Her mother took her to the emergency room where she had a chest x-ray. It was reported that there was no detection of wheezing, swelling or pulmonary embolism. She was treated with albuterol which "did not seem to help." As of 14-MAR-2007, the patient was improving her arm and chest were "just sore." No further information is available.


Changed on 7/31/2010

274470 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:New York
Vaccinated:2007-03-13
Onset:2007-03-13
Submitted:2007-03-15
Entered:2007-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0186U / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1967AA / 0 RA / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2456AA / 4 RA / UN

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain, Abdominal pain upper, Chest discomfort, Chest pain, Chest X-ray, Dyspnoea, Neck pain, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Chest X-ray, 03/13?/07
CDC 'Split Type':

Write-up:Severe arm and neck pain, chest tightness, 2 hour post vaccine. No prior history of asthma, abdominal pain. Seen in the ER and discharged with Albuterol. This is in follow-up to report(s) previously submitted on 4/13/2007. Information has been received from a registered nurse and a licensed practical nurse concerning a 12 year old female student with no pertinent medical history who on 13-MAR-2007, at 16:45 was vaccinated, intramuscularly into the left arm, with a 0.5 mlm first dose of GARDASIL (lot #655618/0186U) concomitantly with a first dose of MENACTRA (lot #0167AA) and a fifth dose of ADACEL (lot #C2456AA) into the right arm. On 13-MAR-2007, at 17:45 (also, reported as 2 hours after vaccination), the patient developed severe arm and neck pain, chest tightness and abdominal pain. At bedtime, the patient had difficulty breathing and pain in her chest. Her mother took her to the emergency room where she had a chest x-ray. It was reported that there was no detection of wheezing, swelling or pulmonary embolism. She was treated with albuterol which "did not seem to help." As of 14-MAR-2007, the patient was improving her arm and chest were "just sore." No further information is available.


Changed on 4/13/2011

274470 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:New York
Vaccinated:2007-03-13
Onset:2007-03-13
Submitted:2007-03-15
Entered:2007-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0186U / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1967AA / 0 RA / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2456AA / 4 RA / UN

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain, Abdominal pain upper, Chest discomfort, Chest pain, Chest X-ray, Dyspnoea, Neck pain, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Chest X-ray, 03/13?/07
CDC 'Split Type':

Write-up:Severe arm and neck pain, chest tightness, 2 hour post vaccine. No prior history of asthma, abdominal pain. Seen in the ER and discharged with Albuterol. This is in follow-up to report(s) previously submitted on 4/13/2007. Information has been received from a registered nurse and a licensed practical nurse concerning a 12 year old female student with no pertinent medical history who on 13-MAR-2007, at 16:45 was vaccinated, intramuscularly into the left arm, with a 0.5 mlm first dose of GARDASIL (lot #655618/0186U) concomitantly with a first dose of MENACTRA (lot #0167AA) and a fifth dose of ADACEL (lot #C2456AA) into the right arm. On 13-MAR-2007, at 17:45 (also, reported as 2 hours after vaccination), the patient developed severe arm and neck pain, chest tightness and abdominal pain. At bedtime, the patient had difficulty breathing and pain in her chest. Her mother took her to the emergency room where she had a chest x-ray. It was reported that there was no detection of wheezing, swelling or pulmonary embolism. She was treated with albuterol which "did not seem to help." As of 14-MAR-2007, the patient was improving her arm and chest were "just sore." No further information is available.


Changed on 5/13/2011

274470 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:New York
Vaccinated:2007-03-13
Onset:2007-03-13
Submitted:2007-03-15
Entered:2007-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0186U / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1967AA / 0 RA / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2456AA / 4 RA / UN

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain, Abdominal pain upper, Chest discomfort, Chest pain, Chest X-ray, Dyspnoea, Neck pain, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Chest X-ray, 03/13?/07
CDC 'Split Type':

Write-up:Severe arm and neck pain, chest tightness, 2 hour post vaccine. No prior history of asthma, abdominal pain. Seen in the ER and discharged with Albuterol. This is in follow-up to report(s) previously submitted on 4/13/2007. Information has been received from a registered nurse and a licensed practical nurse concerning a 12 year old female student with no pertinent medical history who on 13-MAR-2007, at 16:45 was vaccinated, intramuscularly into the left arm, with a 0.5 mlm first dose of GARDASIL (lot #655618/0186U) concomitantly with a first dose of MENACTRA (lot #0167AA) and a fifth dose of ADACEL (lot #C2456AA) into the right arm. On 13-MAR-2007, at 17:45 (also, reported as 2 hours after vaccination), the patient developed severe arm and neck pain, chest tightness and abdominal pain. At bedtime, the patient had difficulty breathing and pain in her chest. Her mother took her to the emergency room where she had a chest x-ray. It was reported that there was no detection of wheezing, swelling or pulmonary embolism. She was treated with albuterol which "did not seem to help." As of 14-MAR-2007, the patient was improving her arm and chest were "just sore." No further information is available.


Changed on 6/11/2011

274470 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:New York
Vaccinated:2007-03-13
Onset:2007-03-13
Submitted:2007-03-15
Entered:2007-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0186U / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1967AA / 0 RA / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2456AA / 4 RA / UN

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain, Abdominal pain upper, Chest discomfort, Chest pain, Chest X-ray, Dyspnoea, Neck pain, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Chest X-ray, 03/13?/07
CDC 'Split Type':

Write-up:Severe arm and neck pain, chest tightness, 2 hour post vaccine. No prior history of asthma, abdominal pain. Seen in the ER and discharged with Albuterol. This is in follow-up to report(s) previously submitted on 4/13/2007. Information has been received from a registered nurse and a licensed practical nurse concerning a 12 year old female student with no pertinent medical history who on 13-MAR-2007, at 16:45 was vaccinated, intramuscularly into the left arm, with a 0.5 mlm first dose of GARDASIL (lot #655618/0186U) concomitantly with a first dose of MENACTRA (lot #0167AA) and a fifth dose of ADACEL (lot #C2456AA) into the right arm. On 13-MAR-2007, at 17:45 (also, reported as 2 hours after vaccination), the patient developed severe arm and neck pain, chest tightness and abdominal pain. At bedtime, the patient had difficulty breathing and pain in her chest. Her mother took her to the emergency room where she had a chest x-ray. It was reported that there was no detection of wheezing, swelling or pulmonary embolism. She was treated with albuterol which "did not seem to help." As of 14-MAR-2007, the patient was improving her arm and chest were "just sore." No further information is available.


Changed on 5/14/2017

274470 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:New York
Vaccinated:2007-03-13
Onset:2007-03-13
Submitted:2007-03-15
Entered:2007-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0186U / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1967AA / 0 RA / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2456AA / 4 RA / UN

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain, Abdominal pain upper, Chest discomfort, Chest pain, Chest X-ray, Dyspnoea, Neck pain, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Chest X-ray, 03/13?/07
CDC 'Split Type':

Write-up:Severe arm and neck pain, chest tightness, 2 hour post vaccine. No prior history of asthma, abdominal pain. Seen in the ER and discharged with Albuterol. This is in follow-up to report(s) previously submitted on 4/13/2007. Information has been received from a registered nurse and a licensed practical nurse concerning a 12 year old female student with no pertinent medical history who on 13-MAR-2007, at 16:45 was vaccinated, intramuscularly into the left arm, with a 0.5 mlm first dose of GARDASIL (lot #655618/0186U) concomitantly with a first dose of MENACTRA (lot #0167AA) and a fifth dose of ADACEL (lot #C2456AA) into the right arm. On 13-MAR-2007, at 17:45 (also, reported as 2 hours after vaccination), the patient developed severe arm and neck pain, chest tightness and abdominal pain. At bedtime, the patient had difficulty breathing and pain in her chest. Her mother took her to the emergency room where she had a chest x-ray. It was reported that there was no detection of wheezing, swelling or pulmonary embolism. She was treated with albuterol which "did not seem to help." As of 14-MAR-2007, the patient was improving her arm and chest were "just sore." No further information is available.


Changed on 9/14/2017

274470 Before After
VAERS Form:(blank) 1
Age:12.0
Gender:Female
Location:New York
Vaccinated:2007-03-13
Onset:2007-03-13
Submitted:2007-03-15
Entered:2007-03-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0186U / 0 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1967AA / 0 1 RA / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2456AA / 4 5 RA / UN

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain, Chest discomfort, Neck pain, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Chest X-ray, 03/13?/07
CDC 'Split Type':

Write-up:Severe arm and neck pain, chest tightness, 2 hour post vaccine. No prior history of asthma, abdominal pain. Seen in the ER and discharged with Albuterol. This is in follow-up to report(s) previously submitted on 4/13/2007. Information has been received from a registered nurse and a licensed practical nurse concerning a 12 year old female student with no pertinent medical history who on 13-MAR-2007, at 16:45 was vaccinated, intramuscularly into the left arm, with a 0.5 mlm first dose of GARDASIL (lot #655618/0186U) concomitantly with a first dose of MENACTRA (lot #0167AA) and a fifth dose of ADACEL (lot #C2456AA) into the right arm. On 13-MAR-2007, at 17:45 (also, reported as 2 hours after vaccination), the patient developed severe arm and neck pain, chest tightness and abdominal pain. At bedtime, the patient had difficulty breathing and pain in her chest. Her mother took her to the emergency room where she had a chest x-ray. It was reported that there was no detection of wheezing, swelling or pulmonary embolism. She was treated with albuterol which "did not seem to help." As of 14-MAR-2007, the patient was improving her arm and chest were "just sore." No further information is available.


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