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This is VAERS ID 276160

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 276160
Age:18.0
Gender:Female
Location:Nebraska
Vaccinated:2007-01-15
Onset:2007-01-15
Submitted:2007-04-06
Entered:2007-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 655619/1427F / 0 UN / -

Administered by: Other      Purchased by: Unknown
Symptoms: Dyskinesia, Pallor, Syncope

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

Write-up:Information has been received from a registered nurse concerning an 18 year old female patient who on 15, Jan 2007 was vaccinated with a first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast) (lot # 655619/1427F). Concomitant suspect vaccination included a"dose of diphtheria toxoid (+) pertussis acellular 3-component vaccine (+) tetanus toxoid (BOOSTRIX) and a dose of meningoxoccal ACYW conj vaccine (dip toxoid) (MENACTRA). On 15, Jan 2007, within 2 minutes after her vaccinations. the patient became pale an


Changed on 12/8/2009

VAERS ID: 276160 Before After
Age:18.0
Gender:Female
Location:Nebraska
Vaccinated:2007-01-15
Onset:2007-01-15
Submitted:2007-04-06
Entered:2007-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 655619/1427F / 0 UN / -

Administered by: Other      Purchased by: Unknown Other
Symptoms: Dyskinesia, Pallor, Syncope

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type': (blank) WAES0703USA01014

Write-up:Information has been received from a registered nurse concerning an 18 year old female patient who on 15, Jan 2007 was vaccinated with a first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast) (lot # 655619/1427F). Concomitant suspect vaccination included a"dose a dose of diphtheria toxoid (+) (=) pertussis acellular 3-component vaccine (+) tetanus toxoid (BOOSTRIX) (BOOSTRIX; and a dose of meningoxoccal ACYW conj vaccine (dip toxoid) (MENACTRA). On 15, Jan 2007, within 2 minutes after her vaccinations. the patient became pale an and fainted. The nurse also reported that while unconscious, the patient had jerking motions which lasted a couple of seconds. The patient was reported to have rested in the office for 15 minutes and then went home recovered. Additional information has been requested.


Changed on 3/2/2010

VAERS ID: 276160 Before After
Age:18.0
Gender:Female
Location:Nebraska
Vaccinated:2007-01-15
Onset:2007-01-15
Submitted:2007-04-06
Entered:2007-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 655619/1427F 1427F / 0 UN / - UN
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR - / - UN / UN
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN

Administered by: Other Private      Purchased by: Other Private
Symptoms: Dyskinesia, Pallor, Syncope

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type': WAES0703USA01014

Write-up:Information has been received from a registered nurse concerning an 18 year old female patient who on 15, Jan 2007 was vaccinated with a first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast) (lot # 655619/1427F). Concomitant suspect vaccination included a dose of diphtheria toxoid (=) (+) pertussis acellular 3-component vaccine (+) tetanus toxoid (BOOSTRIX; (BOOSTRIX) and a dose of meningoxoccal ACYW conj vaccine (dip toxoid) (MENACTRA). On 15, Jan 2007, within 2 minutes after her vaccinations. the patient became pale and fainted. The nurse also reported that while unconscious, the patient had jerking motions which lasted a couple of seconds. The patient was reported to have rested in the office for 15 minutes and then went home recovered. Additional information has been requested. This is in follow-up to report(s) previously submitted on 4/6/2007. On 07-May-2007 follow-up information was received from a registered nurse who indicated that the patient, after immediately receiving the vaccine, became lightheaded and appeared to faint. Her eyes rolled back and she became pale with twitching and jerking motions of the upper extremities which lasted for less than 5 seconds. The patient spontaneously recovered after lying down. No further information was provided.


Changed on 4/7/2010

VAERS ID: 276160 Before After
Age:18.0
Gender:Female
Location:Nebraska
Vaccinated:2007-01-15
Onset:2007-01-15
Submitted:2007-04-06
Entered:2007-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1427F / 0 UN / UN
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / - UN / UN
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Dyskinesia, Muscle twitching, Pallor, Syncope, Gaze palsy, Immediate post-injection reaction

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type': WAES0703USA01014

Write-up:Information has been received from a registered nurse concerning an 18 year old female patient who on 15, Jan 2007 was vaccinated with a first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast) (lot # 655619/1427F). Concomitant suspect vaccination included a dose of diphtheria toxoid (+) pertussis acellular 3-component vaccine (+) tetanus toxoid (BOOSTRIX) and a dose of meningoxoccal ACYW conj vaccine (dip toxoid) (MENACTRA). On 15, Jan 2007, within 2 minutes after her vaccinations. the patient became pale and fainted. The nurse also reported that while unconscious, the patient had jerking motions which lasted a couple of seconds. The patient was reported to have rested in the office for 15 minutes and then went home recovered. Additional information has been requested. This is in follow-up to report(s) previously submitted on 4/6/2007. On 07-May-2007 follow-up information was received from a registered nurse who indicated that the patient, after immediately receiving the vaccine, became lightheaded and appeared to faint. Her eyes rolled back and she became pale with twitching and jerking motions of the upper extremities which lasted for less than 5 seconds. The patient spontaneously recovered after lying down. No further information was provided.


Changed on 6/14/2014

VAERS ID: 276160 Before After
Age:18.0
Gender:Female
Location:Nebraska
Vaccinated:2007-01-15
Onset:2007-01-15
Submitted:2007-04-06
Entered:2007-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1427F / 0 UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / - UN / UN
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Dyskinesia, Muscle twitching, Pallor, Syncope, Gaze palsy, Immediate post-injection reaction

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type': WAES0703USA01014

Write-up:Information has been received from a registered nurse concerning an 18 year old female patient who on 15, Jan 2007 was vaccinated with a first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast) (lot # 655619/1427F). Concomitant suspect vaccination included a dose of diphtheria toxoid (+) pertussis acellular 3-component vaccine (+) tetanus toxoid (BOOSTRIX) and a dose of meningoxoccal ACYW conj vaccine (dip toxoid) (MENACTRA). On 15, Jan 2007, within 2 minutes after her vaccinations. the patient became pale and fainted. The nurse also reported that while unconscious, the patient had jerking motions which lasted a couple of seconds. The patient was reported to have rested in the office for 15 minutes and then went home recovered. Additional information has been requested. This is in follow-up to report(s) previously submitted on 4/6/2007. On 07-May-2007 follow-up information was received from a registered nurse who indicated that the patient, after immediately receiving the vaccine, became lightheaded and appeared to faint. Her eyes rolled back and she became pale with twitching and jerking motions of the upper extremities which lasted for less than 5 seconds. The patient spontaneously recovered after lying down. No further information was provided.


Changed on 5/14/2017

VAERS ID: 276160 Before After
Age:18.0
Gender:Female
Location:Nebraska
Vaccinated:2007-01-15
Onset:2007-01-15
Submitted:2007-04-06
Entered:2007-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1427F / 0 UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / - UN / UN
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS - / - UN / UN

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Dyskinesia, Muscle twitching, Pallor, Syncope, Gaze palsy, Immediate post-injection reaction

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC 'Split Type': WAES0703USA01014

Write-up:Information has been received from a registered nurse concerning an 18 year old female patient who on 15, Jan 2007 was vaccinated with a first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast) (lot # 655619/1427F). Concomitant suspect vaccination included a dose of diphtheria toxoid (+) pertussis acellular 3-component vaccine (+) tetanus toxoid (BOOSTRIX) and a dose of meningoxoccal ACYW conj vaccine (dip toxoid) (MENACTRA). On 15, Jan 2007, within 2 minutes after her vaccinations. the patient became pale and fainted. The nurse also reported that while unconscious, the patient had jerking motions which lasted a couple of seconds. The patient was reported to have rested in the office for 15 minutes and then went home recovered. Additional information has been requested. This is in follow-up to report(s) previously submitted on 4/6/2007. On 07-May-2007 follow-up information was received from a registered nurse who indicated that the patient, after immediately receiving the vaccine, became lightheaded and appeared to faint. Her eyes rolled back and she became pale with twitching and jerking motions of the upper extremities which lasted for less than 5 seconds. The patient spontaneously recovered after lying down. No further information was provided.


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