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This is VAERS ID 276602

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

276602
VAERS Form:
Age:18.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-03
Onset:2007-04-03
Submitted:2007-04-12
Entered:2007-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB14BAA / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR U1968AA / 0 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC526014AA / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Loss of consciousness, Muscle rigidity, Pallor, Staring, Gaze palsy

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:
Preexisting Conditions: Allergic rhinitis, exercise induced asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:5 minutes after HPV vaccine was given patient became pale, her eyes rolled back in her head, and she became rigid, she lost conscious 30 seconds. When she came to she had postical s/s of a blank stare for about 5-10 seconds. She did become A x O x S. BP 1"16/ 78 P 64, Pulse O2 97%. Before vaccine BP 115/65


Changed on 12/8/2009

276602 Before After
VAERS Form:
Age:18.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-03
Onset:2007-04-03
Submitted:2007-04-12
Entered:2007-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB14BAA / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR U1968AA / 0 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC526014AA / 0 LA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Loss of consciousness, Muscle rigidity, Pallor, Staring, Gaze palsy

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:
Preexisting Conditions: Allergic rhinitis, exercise induced asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:5 minutes after HPV vaccine was given patient became pale, her eyes rolled back in her head, and she became rigid, she lost conscious 30 seconds. When she came to she had postical s/s of a blank stare for about 5-10 seconds. She did become A x O x S. BP 1"16/ 116/ 78 P 64, Pulse O2 97%. Before vaccine BP 115/65


Changed on 4/7/2010

276602 Before After
VAERS Form:
Age:18.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-03
Onset:2007-04-03
Submitted:2007-04-12
Entered:2007-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB14BAA / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U1968AA / 0 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC526014AA / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Loss of consciousness, Muscle rigidity, Pallor, Staring, Gaze palsy

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:
Preexisting Conditions: Allergic rhinitis, exercise induced asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:5 minutes after HPV vaccine was given patient became pale, her eyes rolled back in her head, and she became rigid, she lost conscious 30 seconds. When she came to she had postical s/s of a blank stare for about 5-10 seconds. She did become A x O x S. BP 116/ 78 P 64, Pulse O2 97%. Before vaccine BP 115/65


Changed on 5/14/2017

276602 Before After
VAERS Form:
Age:18.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-03
Onset:2007-04-03
Submitted:2007-04-12
Entered:2007-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB14BAA / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U1968AA / 0 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC526014AA / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Loss of consciousness, Muscle rigidity, Pallor, Staring, Gaze palsy

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:
Preexisting Conditions: Allergic rhinitis, exercise induced asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:5 minutes after HPV vaccine was given patient became pale, her eyes rolled back in her head, and she became rigid, she lost conscious 30 seconds. When she came to she had postical s/s of a blank stare for about 5-10 seconds. She did become A x O x S. BP 116/ 78 P 64, Pulse O2 97%. Before vaccine BP 115/65


Changed on 9/14/2017

276602 Before After
VAERS Form:(blank) 1
Age:18.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-03
Onset:2007-04-03
Submitted:2007-04-12
Entered:2007-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB14BAA / 0 1 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 0 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1968AA / 0 1 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC526014AA / 0 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Loss of consciousness, Muscle rigidity, Pallor, Staring, Gaze palsy

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:
Preexisting Conditions: Allergic rhinitis, exercise induced asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:5 minutes after HPV vaccine was given patient became pale, her eyes rolled back in her head, and she became rigid, she lost conscious 30 seconds. When she came to she had postical s/s of a blank stare for about 5-10 seconds. She did become A x O x S. BP 116/ 78 P 64, Pulse O2 97%. Before vaccine BP 115/65


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