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This is VAERS ID 275694

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

275694
VAERS Form:
Age:11.0
Gender:Female
Location:California
Vaccinated:2007-04-02
Onset:2007-04-02
Submitted:2007-04-05
Entered:2007-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0181U / - LA / -
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2221BA / - RA / -
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2659AA / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Asthenia, Pallor, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up:Mother explained when child woke up 4-3-07 a day after immunization she noticed her skin was pale, weak and has fever.


Changed on 12/8/2009

275694 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:California
Vaccinated:2007-04-02
Onset:2007-04-02
Submitted:2007-04-05
Entered:2007-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0181U / - LA / -
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2221BA / - RA / -
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2659AA / - - / -

Administered by: Private      Purchased by: Unknown Public
Symptoms: Asthenia, Pallor, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up:Mother explained when child woke up 4-3-07 a day after immunization she noticed her skin was pale, weak and has fever.


Changed on 4/7/2010

275694 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:California
Vaccinated:2007-04-02
Onset:2007-04-02
Submitted:2007-04-05
Entered:2007-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0181U / - LA / -
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2221BA / - RA / -
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2659AA / - - / -

Administered by: Private      Purchased by: Public
Symptoms: Asthenia, Pallor, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up:Mother explained when child woke up 4-3-07 a day after immunization she noticed her skin was pale, weak and has fever.


Changed on 9/14/2017

275694 Before After
VAERS Form:(blank) 1
Age:11.0
Gender:Female
Location:California
Vaccinated:2007-04-02
Onset:2007-04-02
Submitted:2007-04-05
Entered:2007-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0181U / - UNK LA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2221BA / - UNK RA / -
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2659AA / - UNK - / -

Administered by: Private      Purchased by: Public
Symptoms: Asthenia, Pallor, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up:Mother explained when child woke up 4-3-07 a day after immunization she noticed her skin was pale, weak and has fever.


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