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This is VAERS ID 276063

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

276063
VAERS Form:
Age:13.0
Gender:Female
Location:Rhode Island
Vaccinated:2007-04-05
Onset:2007-04-05
Submitted:2007-04-11
Entered:2007-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / 0 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1300F / 1 RA / SC

Administered by: Private      Purchased by: Unknown
Symptoms: Blood pressure decreased, Hyperhidrosis, Pallor, Pharyngolaryngeal pain, Syncope

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: anaphylaxis to bees (epi pen)
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up:2-3 min after receiving vaccination while standing had syncopal episode, sweaty, shaking sore throat white lips after 5-10 mins. 12 cups of H2O felt better BP 90/60 BP normal taken prior to exam 106/62 P 80


Changed on 12/8/2009

276063 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Rhode Island
Vaccinated:2007-04-05
Onset:2007-04-05
Submitted:2007-04-11
Entered:2007-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / 0 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1300F / 1 RA / SC

Administered by: Private      Purchased by: Unknown Public
Symptoms: Blood pressure decreased, Hyperhidrosis, Pallor, Pharyngolaryngeal pain, Syncope, Tremor

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: anaphylaxis to bees (epi pen)
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up:2-3 min after receiving vaccination while standing had syncopal episode, sweaty, shaking sore throat white lips after 5-10 mins. 12 cups of H2O felt better BP 90/60 BP normal taken prior to exam 106/62 P 80


Changed on 9/14/2017

276063 Before After
VAERS Form:(blank) 1
Age:13.0
Gender:Female
Location:Rhode Island
Vaccinated:2007-04-05
Onset:2007-04-05
Submitted:2007-04-11
Entered:2007-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / 0 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1300F / 1 2 RA / SC

Administered by: Private      Purchased by: Public
Symptoms: Blood pressure decreased, Hyperhidrosis, Pallor, Pharyngolaryngeal pain, Syncope, Tremor

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: anaphylaxis to bees (epi pen)
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up:2-3 min after receiving vaccination while standing had syncopal episode, sweaty, shaking sore throat white lips after 5-10 mins. 12 cups of H2O felt better BP 90/60 BP normal taken prior to exam 106/62 P 80


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Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=276063&WAYBACKHISTORY=ON


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