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This is VAERS ID 276541

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

276541
VAERS Form:
Age:12.0
Gender:Female
Location:Louisiana
Vaccinated:2007-03-29
Onset:2007-03-29
Submitted:2007-04-13
Entered:2007-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0960F / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2061AA / 0 LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Atrioventricular block first degree, Blood glucose increased, Chest X-ray, Computerised tomogram, Echocardiogram

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Hx headaches / depression / systolic murmur
Allergies:
Diagnostic Lab Data: CBC with diff, LMP, BHCG, EKG, Echocardiogram, head CT scan, Chest X-ray, EEG
CDC 'Split Type':

Write-up:patient collapsed 15 to 20 minutes after receiving MCV4 and Gardasil vaccines.


Changed on 12/8/2009

276541 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Louisiana
Vaccinated:2007-03-29
Onset:2007-03-29
Submitted:2007-04-13
Entered:2007-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0960F / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2061AA / 0 LA / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Atrioventricular block first degree, Blood glucose increased, Chest X-ray, Computerised tomogram, Echocardiogram, Electrocardiogram, Electroencephalogram, Full blood count, Head injury, Headache, Loss of consciousness, Pregnancy test, Sinus arrhythmia, Sinus tachycardia, 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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Hx headaches / depression / systolic murmur records received 6/20/07-PMH: Migraines, depression and aggressive behavior.
Allergies:
Diagnostic Lab Data: CBC with diff, LMP, BHCG, EKG, Echocardiogram, head CT scan, Chest X-ray, EEG records received 6/20/07-CT head negative. Doppler echocardiogram normal. Sinus tachycardia with sinus arrhythmia. EEG normal. EKG sinus rhythm with 1st degree A
CDC 'Split Type':

Write-up:patient collapsed 15 to 20 minutes after receiving MCV4 and Gardasil vaccines. 06/20/07-records received from facility for DOS 3/29-3/30/07-DC DX: Syncope. Head Trauma. After injection positive loss of consciousness for about 2-3 minutes. No nausea, vomiting fever or chills but headache for about 2 days. No visual changes.


Changed on 4/7/2010

276541 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Louisiana
Vaccinated:2007-03-29
Onset:2007-03-29
Submitted:2007-04-13
Entered:2007-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0960F / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2061AA / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Atrioventricular block first degree, Blood glucose increased, Chest X-ray, Computerised tomogram, Echocardiogram, Electrocardiogram, Electroencephalogram, Full blood count, Head injury, Headache, Loss of consciousness, Pregnancy test, Sinus arrhythmia, Sinus tachycardia, 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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Hx headaches / depression / systolic murmur records received 6/20/07-PMH: Migraines, depression and aggressive behavior.
Allergies:
Diagnostic Lab Data: CBC with diff, LMP, BHCG, EKG, Echocardiogram, head CT scan, Chest X-ray, EEG records received 6/20/07-CT head negative. Doppler echocardiogram normal. Sinus tachycardia with sinus arrhythmia. EEG normal. EKG sinus rhythm with 1st degree A
CDC 'Split Type':

Write-up:patient collapsed 15 to 20 minutes after receiving MCV4 and Gardasil vaccines. 06/20/07-records received from facility for DOS 3/29-3/30/07-DC DX: Syncope. Head Trauma. After injection positive loss of consciousness for about 2-3 minutes. No nausea, vomiting fever or chills but headache for about 2 days. No visual changes.


Changed on 8/31/2010

276541 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Louisiana
Vaccinated:2007-03-29
Onset:2007-03-29
Submitted:2007-04-13
Entered:2007-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0960F / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2061AA / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Atrioventricular block first degree, Blood glucose increased, Chest X-ray, Computerised tomogram, Echocardiogram, Electrocardiogram, Electroencephalogram, Full blood count, Head injury, Headache, Loss of consciousness, Pregnancy test, Sinus arrhythmia, Sinus tachycardia, 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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Hx headaches / depression / systolic murmur records received 6/20/07-PMH: Migraines, depression and aggressive behavior.
Allergies:
Diagnostic Lab Data: CBC with diff, LMP, BHCG, EKG, Echocardiogram, head CT scan, Chest X-ray, EEG records received 6/20/07-CT head negative. Doppler echocardiogram normal. Sinus tachycardia with sinus arrhythmia. EEG normal. EKG sinus rhythm with 1st degree A
CDC 'Split Type':

Write-up:patient collapsed 15 to 20 minutes after receiving MCV4 and Gardasil vaccines. 06/20/07-records received from facility for DOS 3/29-3/30/07-DC DX: Syncope. Head Trauma. After injection positive loss of consciousness for about 2-3 minutes. No nausea, vomiting fever or chills but headache for about 2 days. No visual changes.


Changed on 4/13/2011

276541 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Louisiana
Vaccinated:2007-03-29
Onset:2007-03-29
Submitted:2007-04-13
Entered:2007-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0960F / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2061AA / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Atrioventricular block first degree, Blood glucose increased, Chest X-ray, Computerised tomogram, Echocardiogram, Electrocardiogram, Electroencephalogram, Full blood count, Head injury, Headache, Loss of consciousness, Pregnancy test, Sinus arrhythmia, Sinus tachycardia, 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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Hx headaches / depression / systolic murmur records received 6/20/07-PMH: Migraines, depression and aggressive behavior.
Allergies:
Diagnostic Lab Data: CBC with diff, LMP, BHCG, EKG, Echocardiogram, head CT scan, Chest X-ray, EEG records received 6/20/07-CT head negative. Doppler echocardiogram normal. Sinus tachycardia with sinus arrhythmia. EEG normal. EKG sinus rhythm with 1st degree A
CDC 'Split Type':

Write-up:patient collapsed 15 to 20 minutes after receiving MCV4 and Gardasil vaccines. 06/20/07-records received from facility for DOS 3/29-3/30/07-DC DX: Syncope. Head Trauma. After injection positive loss of consciousness for about 2-3 minutes. No nausea, vomiting fever or chills but headache for about 2 days. No visual changes.


Changed on 5/13/2011

276541 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Louisiana
Vaccinated:2007-03-29
Onset:2007-03-29
Submitted:2007-04-13
Entered:2007-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0960F / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2061AA / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Atrioventricular block first degree, Blood glucose increased, Chest X-ray, Computerised tomogram, Echocardiogram, Electrocardiogram, Electroencephalogram, Full blood count, Head injury, Headache, Loss of consciousness, Pregnancy test, Sinus arrhythmia, Sinus tachycardia, 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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Hx headaches / depression / systolic murmur records received 6/20/07-PMH: Migraines, depression and aggressive behavior.
Allergies:
Diagnostic Lab Data: CBC with diff, LMP, BHCG, EKG, Echocardiogram, head CT scan, Chest X-ray, EEG records received 6/20/07-CT head negative. Doppler echocardiogram normal. Sinus tachycardia with sinus arrhythmia. EEG normal. EKG sinus rhythm with 1st degree A
CDC 'Split Type':

Write-up:patient collapsed 15 to 20 minutes after receiving MCV4 and Gardasil vaccines. 06/20/07-records received from facility for DOS 3/29-3/30/07-DC DX: Syncope. Head Trauma. After injection positive loss of consciousness for about 2-3 minutes. No nausea, vomiting fever or chills but headache for about 2 days. No visual changes.


Changed on 6/11/2011

276541 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Louisiana
Vaccinated:2007-03-29
Onset:2007-03-29
Submitted:2007-04-13
Entered:2007-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0960F / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2061AA / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Atrioventricular block first degree, Blood glucose increased, Chest X-ray, Computerised tomogram, Echocardiogram, Electrocardiogram, Electroencephalogram, Full blood count, Head injury, Headache, Loss of consciousness, Pregnancy test, Sinus arrhythmia, Sinus tachycardia, 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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Hx headaches / depression / systolic murmur records received 6/20/07-PMH: Migraines, depression and aggressive behavior.
Allergies:
Diagnostic Lab Data: CBC with diff, LMP, BHCG, EKG, Echocardiogram, head CT scan, Chest X-ray, EEG records received 6/20/07-CT head negative. Doppler echocardiogram normal. Sinus tachycardia with sinus arrhythmia. EEG normal. EKG sinus rhythm with 1st degree A
CDC 'Split Type':

Write-up:patient collapsed 15 to 20 minutes after receiving MCV4 and Gardasil vaccines. 06/20/07-records received from facility for DOS 3/29-3/30/07-DC DX: Syncope. Head Trauma. After injection positive loss of consciousness for about 2-3 minutes. No nausea, vomiting fever or chills but headache for about 2 days. No visual changes.


Changed on 5/14/2017

276541 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Louisiana
Vaccinated:2007-03-29
Onset:2007-03-29
Submitted:2007-04-13
Entered:2007-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0960F / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2061AA / 0 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Atrioventricular block first degree, Blood glucose increased, Chest X-ray, Computerised tomogram, Echocardiogram, Electrocardiogram, Electroencephalogram, Full blood count, Head injury, Headache, Loss of consciousness, Pregnancy test, Sinus arrhythmia, Sinus tachycardia, 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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Hx headaches / depression / systolic murmur records received 6/20/07-PMH: Migraines, depression and aggressive behavior.
Allergies:
Diagnostic Lab Data: CBC with diff, LMP, BHCG, EKG, Echocardiogram, head CT scan, Chest X-ray, EEG records received 6/20/07-CT head negative. Doppler echocardiogram normal. Sinus tachycardia with sinus arrhythmia. EEG normal. EKG sinus rhythm with 1st degree A AV block. CBC WNL. Glucose 104. DC with 24 hour Holter monitor.
CDC 'Split Type':

Write-up:patient collapsed 15 to 20 minutes after receiving MCV4 and Gardasil vaccines. 06/20/07-records received from facility for DOS 3/29-3/30/07-DC DX: Syncope. Head Trauma. After injection positive loss of consciousness for about 2-3 minutes. No nausea, vomiting fever or chills but headache for about 2 days. No visual changes.


Changed on 9/14/2017

276541 Before After
VAERS Form:(blank) 1
Age:12.0
Gender:Female
Location:Louisiana
Vaccinated:2007-03-29
Onset:2007-03-29
Submitted:2007-04-13
Entered:2007-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0960F / 0 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2061AA / 0 1 LA / IM

Administered by: Public      Purchased by: Public
Symptoms: Chest X-ray, Computerised tomogram, Echocardiogram, Electrocardiogram, Electroencephalogram, Full blood count, Pregnancy test

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Hx headaches / depression / systolic murmur records received 6/20/07-PMH: Migraines, depression and aggressive behavior.
Allergies:
Diagnostic Lab Data: CBC with diff, LMP, BHCG, EKG, Echocardiogram, head CT scan, Chest X-ray, EEG records received 6/20/07-CT head negative. Doppler echocardiogram normal. Sinus tachycardia with sinus arrhythmia. EEG normal. EKG sinus rhythm with 1st degree AV block. CBC WNL. Glucose 104. DC with 24 hour Holter monitor.
CDC 'Split Type':

Write-up:patient collapsed 15 to 20 minutes after receiving MCV4 and Gardasil vaccines. 06/20/07-records received from facility for DOS 3/29-3/30/07-DC DX: Syncope. Head Trauma. After injection positive loss of consciousness for about 2-3 minutes. No nausea, vomiting fever or chills but headache for about 2 days. No visual changes.


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