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This is VAERS ID 276829

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

276829
VAERS Form:
Age:13.0
Gender:Female
Location:California
Vaccinated:2007-03-15
Onset:2007-03-19
Submitted:2007-04-13
Entered:2007-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0962F / 0 UN / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR - / - UN / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR - / - UN / UN

Administered by: Other      Purchased by: Unknown
Symptoms: Menorrhagia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: tuberculin purified protein derivative
Current Illness:
Preexisting Conditions: Unk
Allergies:
Diagnostic Lab Data: Unk
CDC 'Split Type':

Write-up:Information has been received from a physician concerning a 13 year old female patient who on 15-MAR-2007 was vaccinated IM with a first dose of Gardasil, lot #654510/0962F. Concomitant therapy included Adacel, Menactra and tuberculin purified protein der"ivative. On 19-MAR-2007 the patient developed an off cycle additional menstrual cycle with a heavy flow. Unspecified medical attention was sought. The patient''''s outcome was unknown. Additional information has been requested.


Changed on 12/8/2009

276829 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:California
Vaccinated:2007-03-15
Onset:2007-03-19
Submitted:2007-04-13
Entered:2007-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0962F / 0 UN / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR - / - UN / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR - / - UN / UN

Administered by: Other      Purchased by: Unknown Other
Symptoms: Menorrhagia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: tuberculin purified protein derivative
Current Illness:
Preexisting Conditions: Unk
Allergies:
Diagnostic Lab Data: Unk
CDC 'Split Type': (blank) WAES0703USA03790

Write-up:Information has been received from a physician concerning a 13 year old female patient who on 15-MAR-2007 was vaccinated IM with a first dose of Gardasil, lot #654510/0962F. Concomitant therapy included Adacel, Menactra and tuberculin purified protein der"ivative. derivative. On 19-MAR-2007 the patient developed an off cycle additional menstrual cycle with a heavy flow. Unspecified medical attention was sought. The patient''''s patient''s outcome was unknown. Additional information has been requested.


Changed on 3/2/2010

276829 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:California
Vaccinated:2007-03-15
Onset:2007-03-19
Submitted:2007-04-13
Entered:2007-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0962F / 0 UN / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR - / - UN / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR - / - UN / UN

Administered by: Other Private      Purchased by: Other Public
Symptoms: Menorrhagia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: tuberculin purified protein derivative
Current Illness:
Preexisting Conditions: Unk Unknown
Allergies:
Diagnostic Lab Data: Unk Tuberculin purified protein derivative
CDC 'Split Type': WAES0703USA03790

Write-up:Information Initial and follow up information has been received from a physician and a health care professional concerning a 13 year old female patient who on 15-MAR-2007 at 04:30 PM was vaccinated IM with a first dose of Gardasil, GARDASIL vaccine, lot #654510/0962F. Concomitant therapy included Adacel, Menactra ADACEL, MENACTRA and tuberculin purified protein derivative. On 19-MAR-2007 the patient developed an off cycle additional menstrual cycle with a heavy flow. Unspecified medical attention was sought. The patient''s outcome was unknown. Additional information has been requested. This is in follow-up to report (s) previously submitted on 4/13/2007. Additional information has been requested.


Changed on 4/7/2010

276829 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:California
Vaccinated:2007-03-15
Onset:2007-03-19
Submitted:2007-04-13
Entered:2007-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0962F / 0 UN / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / - UN / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR - / - UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Menorrhagia, Tuberculin test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Unknown
Allergies:
Diagnostic Lab Data: Unk Tuberculin purified protein derivative
CDC 'Split Type': WAES0703USA03790

Write-up:Initial and follow up information has been received from a physician and a health care professional concerning a 13 year old female patient who on 15-MAR-2007 at 04:30 PM was vaccinated IM with a first dose of GARDASIL vaccine, lot #654510/0962F. Concomitant therapy included ADACEL, MENACTRA and tuberculin purified protein derivative. On 19-MAR-2007 the patient developed an off cycle additional menstrual cycle with a heavy flow. Unspecified medical attention was sought. The patient''s outcome was unknown. Additional information has been requested. This is in follow-up to report (s) previously submitted on 4/13/2007. Additional information has been requested.


Changed on 9/14/2017

276829 Before After
VAERS Form:(blank) 1
Age:13.0
Gender:Female
Location:California
Vaccinated:2007-03-15
Onset:2007-03-19
Submitted:2007-04-13
Entered:2007-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0962F / 0 1 UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / - UNK UN / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR - / - UNK UN / UN

Administered by: Private      Purchased by: Public
Symptoms: Menorrhagia, Tuberculin test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Unknown
Allergies:
Diagnostic Lab Data: Unk Tuberculin purified protein derivative
CDC 'Split Type': WAES0703USA03790

Write-up:Initial and follow up information has been received from a physician and a health care professional concerning a 13 year old female patient who on 15-MAR-2007 at 04:30 PM was vaccinated IM with a first dose of GARDASIL vaccine, lot #654510/0962F. Concomitant therapy included ADACEL, MENACTRA and tuberculin purified protein derivative. On 19-MAR-2007 the patient developed an off cycle additional menstrual cycle with a heavy flow. Unspecified medical attention was sought. The patient''s outcome was unknown. Additional information has been requested. This is in follow-up to report (s) previously submitted on 4/13/2007. Additional information has been requested.


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