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This is VAERS ID 275830

Case Details

VAERS ID: 275830 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Florida  
Vaccinated:2007-01-12
Onset:2007-01-12
   Days after vaccination:0
Submitted: 2007-04-04
   Days after onset:81
Entered: 2007-04-09
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1427F / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2117AA / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Fall
SMQs:, Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: At the check out patient was standing and then fell on the floor was taken to the room. She was awake, alert, vital signs were normal, stayed in the room for 15-20 minutes and left when she felt better.


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