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This is VAERS ID 276351

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

276351
VAERS Form:
Age:11.0
Gender:Female
Location:New Hampshire
Vaccinated:2007-04-11
Onset:2007-04-11
Submitted:2007-04-16
Entered:2007-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1208F / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR U2221AA / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Blood pressure normal, Fall, Head injury, Heart rate, Neurological examination normal

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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Vital signs stable, neurologicallly stable, per provider note
CDC 'Split Type':

Write-up:Sitting on exam table , received vaccines Gardasil and Menactra. Got down from exam table, stood up and fell forward, hitting forehead on the wall. Nurse pivoted her onto a chair, sitting position. /"Patient''''s eyes were open, back arched, arms straight a"nd posturing/" x approximately 3 seconds. Relaxed - still staring, not alert. Nurse and medical student placed her on exam table reclining.


Changed on 12/8/2009

276351 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:New Hampshire
Vaccinated:2007-04-11
Onset:2007-04-11
Submitted:2007-04-16
Entered:2007-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1208F / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR U2221AA / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Blood pressure normal, Fall, Head injury, Heart rate, Posturing, Staring, Neurological examination normal

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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Vital signs stable, neurologicallly stable, per provider note
CDC 'Split Type': (blank) NH0716

Write-up:Sitting on exam table , received vaccines Gardasil and Menactra. Got down from exam table, stood up and fell forward, hitting forehead on the wall. Nurse pivoted her onto a chair, sitting position. /"Patient''''s "Patient''s eyes were open, back arched, arms straight a"nd posturing/" and posturing" x approximately 3 seconds. Relaxed - still staring, not alert. Nurse and medical student placed her on exam table reclining.


Changed on 4/7/2010

276351 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:New Hampshire
Vaccinated:2007-04-11
Onset:2007-04-11
Submitted:2007-04-16
Entered:2007-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1208F / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U2221AA / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Blood pressure normal, Fall, Head injury, Heart rate, Posturing, Staring, Neurological examination normal

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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Vital signs stable, neurologicallly stable, per provider note
CDC 'Split Type': NH0716

Write-up:Sitting on exam table , received vaccines Gardasil and Menactra. Got down from exam table, stood up and fell forward, hitting forehead on the wall. Nurse pivoted her onto a chair, sitting position. "Patient''s eyes were open, back arched, arms straight and posturing" x approximately 3 seconds. Relaxed - still staring, not alert. Nurse and medical student placed her on exam table reclining.


Changed on 5/14/2017

276351 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:New Hampshire
Vaccinated:2007-04-11
Onset:2007-04-11
Submitted:2007-04-16
Entered:2007-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1208F / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U2221AA / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Blood pressure normal, Fall, Head injury, Heart rate, Posturing, Staring, Neurological examination normal

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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Vital signs stable, neurologicallly stable, per provider note
CDC 'Split Type': NH0716

Write-up:Sitting on exam table , received vaccines Gardasil and Menactra. Got down from exam table, stood up and fell forward, hitting forehead on the wall. Nurse pivoted her onto a chair, sitting position. "Patient''s eyes were open, back arched, arms straight and posturing" x approximately 3 seconds. Relaxed - still staring, not alert. Nurse and medical student placed her on exam table reclining.


Changed on 9/14/2017

276351 Before After
VAERS Form:(blank) 1
Age:11.0
Gender:Female
Location:New Hampshire
Vaccinated:2007-04-11
Onset:2007-04-11
Submitted:2007-04-16
Entered:2007-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1208F / 0 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2221AA / 0 1 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Blood pressure normal, Fall, Head injury, Heart rate, Posturing, Staring, Neurological examination normal

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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Vital signs stable, neurologicallly stable, per provider note
CDC 'Split Type': NH0716

Write-up:Sitting on exam table , received vaccines Gardasil and Menactra. Got down from exam table, stood up and fell forward, hitting forehead on the wall. Nurse pivoted her onto a chair, sitting position. "Patient''s eyes were open, back arched, arms straight and posturing" x approximately 3 seconds. Relaxed - still staring, not alert. Nurse and medical student placed her on exam table reclining.


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