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This is VAERS ID 275734

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

275734
VAERS Form:
Age:14.0
Gender:Female
Location:Maryland
Vaccinated:2007-04-03
Onset:2007-04-03
Submitted:2007-04-06
Entered:2007-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR - / 0 RA / IM
TTOX: TETANUS TOXOID (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Chromatopsia, Dyspnoea, Hypotension, Injection site pain, Oral pain

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: Previous reaction to DPT vaccine (seizure)Previous reaction to dental sealants (multiple canker sores, unexplained muscle twitching, rash on trunk of body)Previous reaction to sulfa based eye drops prescribed for pinkeye
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Within one minute following injections, Bonnie experienced flashing lights in her eye; could only see in bright primary colors; had extreme trouble breathing; experienced pain in top of mouth and throat; pain at injection site; blood pressure was low. Sym"ptoms started to subside after injection of Epinephrine and use of Nebulizer. She has no history of food or pollen allergies.


Changed on 12/8/2009

275734 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Maryland
Vaccinated:2007-04-03
Onset:2007-04-03
Submitted:2007-04-06
Entered:2007-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR - / 0 RA / IM
TTOX: TETANUS TOXOID (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Chromatopsia, Dyspnoea, Hypotension, Injection site pain, Oral pain, Pharyngolaryngeal pain, Photopsia

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: Previous reaction to DPT vaccine (seizure)Previous reaction to dental sealants (multiple canker sores, unexplained muscle twitching, rash on trunk of body)Previous reaction to sulfa based eye drops prescribed for pinkeye
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Within one minute following injections, Bonnie experienced flashing lights in her eye; could only see in bright primary colors; had extreme trouble breathing; experienced pain in top of mouth and throat; pain at injection site; blood pressure was low. Sym"ptoms Symptoms started to subside after injection of Epinephrine and use of Nebulizer. She has no history of food or pollen allergies.


Changed on 4/7/2010

275734 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Maryland
Vaccinated:2007-04-03
Onset:2007-04-03
Submitted:2007-04-06
Entered:2007-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR - / 0 RA / IM
TTOX: TETANUS TOXOID (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Chromatopsia, Dyspnoea, Hypotension, Injection site pain, Oral pain, Pharyngolaryngeal pain, Photopsia

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: Previous reaction to DPT vaccine (seizure)Previous reaction to dental sealants (multiple canker sores, unexplained muscle twitching, rash on trunk of body)Previous reaction to sulfa based eye drops prescribed for pinkeye
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Within one minute following injections, Bonnie experienced flashing lights in her eye; could only see in bright primary colors; had extreme trouble breathing; experienced pain in top of mouth and throat; pain at injection site; blood pressure was low. Symptoms started to subside after injection of Epinephrine and use of Nebulizer. She has no history of food or pollen allergies.


Changed on 1/7/2013

275734 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Maryland
Vaccinated:2007-04-03
Onset:2007-04-03
Submitted:2007-04-06
Entered:2007-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR - / 0 RA / IM
TTOX: TETANUS TOXOID (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LA / IM

Administered by: Private Unknown      Purchased by: Private Unknown
Symptoms: Chromatopsia, Dyspnoea, Hypotension, Injection site pain, Oral pain, Pharyngolaryngeal pain, Photopsia

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: Previous reaction to DPT vaccine (seizure)Previous reaction to dental sealants (multiple canker sores, unexplained muscle twitching, rash on trunk of body)Previous reaction to sulfa based eye drops prescribed for pinkeye
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Within one minute following injections, Bonnie patient experienced flashing lights in her eye; could only see in bright primary colors; had extreme trouble breathing; experienced pain in top of mouth and throat; pain at injection site; blood pressure was low. Symptoms started to subside after injection of Epinephrine and use of Nebulizer. She has no history of food or pollen allergies.


Changed on 6/14/2014

275734 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Maryland
Vaccinated:2007-04-03
Onset:2007-04-03
Submitted:2007-04-06
Entered:2007-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / 0 RA / IM
TTOX: TETANUS TOXOID (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chromatopsia, Dyspnoea, Hypotension, Injection site pain, Oral pain, Pharyngolaryngeal pain, Photopsia

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: Previous reaction to DPT vaccine (seizure)Previous reaction to dental sealants (multiple canker sores, unexplained muscle twitching, rash on trunk of body)Previous reaction to sulfa based eye drops prescribed for pinkeye
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Within one minute following injections, patient experienced flashing lights in her eye; could only see in bright primary colors; had extreme trouble breathing; experienced pain in top of mouth and throat; pain at injection site; blood pressure was low. Symptoms started to subside after injection of Epinephrine and use of Nebulizer. She has no history of food or pollen allergies.


Changed on 3/14/2015

275734 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Maryland
Vaccinated:2007-04-03
Onset:2007-04-03
Submitted:2007-04-06
Entered:2007-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / 0 RA / IM
TTOX: TETANUS TOXOID (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chromatopsia, Dyspnoea, Hypotension, Injection site pain, Oral pain, Pharyngolaryngeal pain, Photopsia

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: Previous reaction to DPT vaccine (seizure)Previous reaction to dental sealants (multiple canker sores, unexplained muscle twitching, rash on trunk of body)Previous reaction to sulfa based eye drops prescribed for pinkeye
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Within one minute following injections, patient experienced flashing lights in her eye; could only see in bright primary colors; had extreme trouble breathing; experienced pain in top of mouth and throat; pain at injection site; blood pressure was low. Symptoms started to subside after injection of Epinephrine and use of Nebulizer. She has no history of food or pollen allergies.


Changed on 9/14/2017

275734 Before After
VAERS Form:(blank) 1
Age:14.0
Gender:Female
Location:Maryland
Vaccinated:2007-04-03
Onset:2007-04-03
Submitted:2007-04-06
Entered:2007-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / 0 1 RA / IM
TTOX: TETANUS TOXOID (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 2 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chromatopsia, Dyspnoea, Hypotension, Injection site pain, Oral pain, Pharyngolaryngeal pain, Photopsia

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: Previous reaction to DPT vaccine (seizure)Previous reaction to dental sealants (multiple canker sores, unexplained muscle twitching, rash on trunk of body)Previous reaction to sulfa based eye drops prescribed for pinkeye
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Within one minute following injections, patient experienced flashing lights in her eye; could only see in bright primary colors; had extreme trouble breathing; experienced pain in top of mouth and throat; pain at injection site; blood pressure was low. Symptoms started to subside after injection of Epinephrine and use of Nebulizer. She has no history of food or pollen allergies.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=275734&WAYBACKHISTORY=ON


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