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This is VAERS ID 277122

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

277122
VAERS Form:
Age:17.0
Gender:Female
Location:New Jersey
Vaccinated:2007-04-10
Onset:2007-04-10
Submitted:2007-04-12
Entered:2007-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0250U / 0 RA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 0 LA / -
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR 4214AA / 0 LA / -

Administered by: Private      Purchased by: Unknown
Symptoms: Cold sweat, Computerised tomogram abnormal, Convulsion, Disorientation, Dizziness

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Migraines
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CT scan - small subdural hematoma (when patient fell she hit her head on a cabinet).
CDC 'Split Type':

Write-up:940 AM found patient on floor with fists lasted approx. 3-5 seconds after patient responsive but c/o headache, dizziness, nausea - BP 122/82 - skin cool and clammy - MD in to check patient c/o of same symptoms but with onset of vomiting - responsive at al"l times but drowsy - transported to hospital 1030 AM. (when patient fell she hit her head on a cabinet).


Changed on 12/8/2009

277122 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:New Jersey
Vaccinated:2007-04-10
Onset:2007-04-10
Submitted:2007-04-12
Entered:2007-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0250U / 0 RA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 0 LA / -
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR 4214AA / 0 LA / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Cold sweat, Computerised tomogram abnormal, Convulsion, Disorientation, Dizziness, Fall, Head injury, Headache, Loss of consciousness, Nausea, Skull X-ray, Somnolence, Spinal X-ray, Spinal X-ray abnormal, Subdural haematoma, Syncope vasovagal, Tenderness, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No 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:
Current Illness: Migraines
Preexisting Conditions: None None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: CT scan - small subdural hematoma (when patient fell she hit her head on a cabinet). Labs and Diagnostics: CT head reveals acute L frontal, parietal, and temporal SDH with midline shift. X-ray cervical spine-mild reversal of kyphosis at C
CDC 'Split Type':

Write-up:940 AM found patient on floor with fists lasted approx. 3-5 seconds after patient responsive but c/o headache, dizziness, nausea - BP 122/82 - skin cool and clammy - MD in to check patient c/o of same symptoms but with onset of vomiting - responsive at al"l all times but drowsy - transported to hospital 1030 AM. (when patient fell she hit her head on a cabinet). 05/29/2007 MR received for o/n hospitalization for subdural hematoma. Pt had a vaso-vagal syncopal episode after receiving vax, which resulted in a fall where pt. hit head. (+) LOC and seizure. PE: (+) for occipital tenderness. Not oriented to date. T4-L5 tenderness. Final DX: Head injury. L Parietal-frontal SDH.


Changed on 4/7/2010

277122 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:New Jersey
Vaccinated:2007-04-10
Onset:2007-04-10
Submitted:2007-04-12
Entered:2007-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0250U / 0 RA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 0 LA / -
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR 4214AA / 0 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Cold sweat, Computerised tomogram abnormal, Convulsion, Dizziness, Fall, Head injury, Headache, Loss of consciousness, Nausea, Skull X-ray, Somnolence, Spinal X-ray, Spinal X-ray abnormal, Subdural haematoma, Syncope vasovagal, Tenderness, Vomiting

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:
Current Illness: Migraines
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: CT scan - small subdural hematoma (when patient fell she hit her head on a cabinet). Labs and Diagnostics: CT head reveals acute L frontal, parietal, and temporal SDH with midline shift. X-ray cervical spine-mild reversal of kyphosis at C
CDC 'Split Type':

Write-up:940 AM found patient on floor with fists lasted approx. 3-5 seconds after patient responsive but c/o headache, dizziness, nausea - BP 122/82 - skin cool and clammy - MD in to check patient c/o of same symptoms but with onset of vomiting - responsive at all times but drowsy - transported to hospital 1030 AM. (when patient fell she hit her head on a cabinet). 05/29/2007 MR received for o/n hospitalization for subdural hematoma. Pt had a vaso-vagal syncopal episode after receiving vax, which resulted in a fall where pt. hit head. (+) LOC and seizure. PE: (+) for occipital tenderness. Not oriented to date. T4-L5 tenderness. Final DX: Head injury. L Parietal-frontal SDH.


Changed on 8/31/2010

277122 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:New Jersey
Vaccinated:2007-04-10
Onset:2007-04-10
Submitted:2007-04-12
Entered:2007-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0250U / 0 RA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 0 LA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR 4214AA / 0 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Cold sweat, Computerised tomogram abnormal, Convulsion, Dizziness, Fall, Head injury, Headache, Loss of consciousness, Nausea, Skull X-ray, Somnolence, Spinal X-ray, Spinal X-ray abnormal, Subdural haematoma, Syncope vasovagal, Tenderness, Vomiting

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:
Current Illness: Migraines
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: CT scan - small subdural hematoma (when patient fell she hit her head on a cabinet). Labs and Diagnostics: CT head reveals acute L frontal, parietal, and temporal SDH with midline shift. X-ray cervical spine-mild reversal of kyphosis at C
CDC 'Split Type':

Write-up:940 AM found patient on floor with fists lasted approx. 3-5 seconds after patient responsive but c/o headache, dizziness, nausea - BP 122/82 - skin cool and clammy - MD in to check patient c/o of same symptoms but with onset of vomiting - responsive at all times but drowsy - transported to hospital 1030 AM. (when patient fell she hit her head on a cabinet). 05/29/2007 MR received for o/n hospitalization for subdural hematoma. Pt had a vaso-vagal syncopal episode after receiving vax, which resulted in a fall where pt. hit head. (+) LOC and seizure. PE: (+) for occipital tenderness. Not oriented to date. T4-L5 tenderness. Final DX: Head injury. L Parietal-frontal SDH.


Changed on 4/13/2011

277122 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:New Jersey
Vaccinated:2007-04-10
Onset:2007-04-10
Submitted:2007-04-12
Entered:2007-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0250U / 0 RA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 0 LA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR 4214AA / 0 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Cold sweat, Computerised tomogram abnormal, Convulsion, Dizziness, Fall, Head injury, Headache, Loss of consciousness, Nausea, Skull X-ray, Somnolence, Spinal X-ray, Spinal X-ray abnormal, Subdural haematoma, Syncope vasovagal, Tenderness, Vomiting

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:
Current Illness: Migraines
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: CT scan - small subdural hematoma (when patient fell she hit her head on a cabinet). Labs and Diagnostics: CT head reveals acute L frontal, parietal, and temporal SDH with midline shift. X-ray cervical spine-mild reversal of kyphosis at C
CDC 'Split Type':

Write-up:940 AM found patient on floor with fists lasted approx. 3-5 seconds after patient responsive but c/o headache, dizziness, nausea - BP 122/82 - skin cool and clammy - MD in to check patient c/o of same symptoms but with onset of vomiting - responsive at all times but drowsy - transported to hospital 1030 AM. (when patient fell she hit her head on a cabinet). 05/29/2007 MR received for o/n hospitalization for subdural hematoma. Pt had a vaso-vagal syncopal episode after receiving vax, which resulted in a fall where pt. hit head. (+) LOC and seizure. PE: (+) for occipital tenderness. Not oriented to date. T4-L5 tenderness. Final DX: Head injury. L Parietal-frontal SDH.


Changed on 5/13/2011

277122 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:New Jersey
Vaccinated:2007-04-10
Onset:2007-04-10
Submitted:2007-04-12
Entered:2007-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0250U / 0 RA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 0 LA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR 4214AA / 0 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Cold sweat, Computerised tomogram abnormal, Convulsion, Dizziness, Fall, Head injury, Headache, Loss of consciousness, Nausea, Skull X-ray, Somnolence, Spinal X-ray, Spinal X-ray abnormal, Subdural haematoma, Syncope vasovagal, Tenderness, Vomiting

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:
Current Illness: Migraines
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: CT scan - small subdural hematoma (when patient fell she hit her head on a cabinet). Labs and Diagnostics: CT head reveals acute L frontal, parietal, and temporal SDH with midline shift. X-ray cervical spine-mild reversal of kyphosis at C
CDC 'Split Type':

Write-up:940 AM found patient on floor with fists lasted approx. 3-5 seconds after patient responsive but c/o headache, dizziness, nausea - BP 122/82 - skin cool and clammy - MD in to check patient c/o of same symptoms but with onset of vomiting - responsive at all times but drowsy - transported to hospital 1030 AM. (when patient fell she hit her head on a cabinet). 05/29/2007 MR received for o/n hospitalization for subdural hematoma. Pt had a vaso-vagal syncopal episode after receiving vax, which resulted in a fall where pt. hit head. (+) LOC and seizure. PE: (+) for occipital tenderness. Not oriented to date. T4-L5 tenderness. Final DX: Head injury. L Parietal-frontal SDH.


Changed on 6/11/2011

277122 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:New Jersey
Vaccinated:2007-04-10
Onset:2007-04-10
Submitted:2007-04-12
Entered:2007-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0250U / 0 RA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 0 LA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR 4214AA / 0 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Cold sweat, Computerised tomogram abnormal, Convulsion, Dizziness, Fall, Head injury, Headache, Loss of consciousness, Nausea, Skull X-ray, Somnolence, Spinal X-ray, Spinal X-ray abnormal, Subdural haematoma, Syncope vasovagal, Tenderness, Vomiting

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:
Current Illness: Migraines
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: CT scan - small subdural hematoma (when patient fell she hit her head on a cabinet). Labs and Diagnostics: CT head reveals acute L frontal, parietal, and temporal SDH with midline shift. X-ray cervical spine-mild reversal of kyphosis at C
CDC 'Split Type':

Write-up:940 AM found patient on floor with fists lasted approx. 3-5 seconds after patient responsive but c/o headache, dizziness, nausea - BP 122/82 - skin cool and clammy - MD in to check patient c/o of same symptoms but with onset of vomiting - responsive at all times but drowsy - transported to hospital 1030 AM. (when patient fell she hit her head on a cabinet). 05/29/2007 MR received for o/n hospitalization for subdural hematoma. Pt had a vaso-vagal syncopal episode after receiving vax, which resulted in a fall where pt. hit head. (+) LOC and seizure. PE: (+) for occipital tenderness. Not oriented to date. T4-L5 tenderness. Final DX: Head injury. L Parietal-frontal SDH.


Changed on 5/14/2017

277122 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:New Jersey
Vaccinated:2007-04-10
Onset:2007-04-10
Submitted:2007-04-12
Entered:2007-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0250U / 0 RA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 0 LA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR 4214AA / 0 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Cold sweat, Computerised tomogram abnormal, Convulsion, Dizziness, Fall, Head injury, Headache, Loss of consciousness, Nausea, Skull X-ray, Somnolence, Spinal X-ray, Spinal X-ray abnormal, Subdural haematoma, Syncope vasovagal, Tenderness, Vomiting

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:
Current Illness: Migraines
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: CT scan - small subdural hematoma (when patient fell she hit her head on a cabinet). Labs and Diagnostics: CT head reveals acute L frontal, parietal, and temporal SDH with midline shift. X-ray cervical spine-mild reversal of kyphosis at C C6-C7 likely related to positioning or muscle spasm. X-ray Skull-no abnormality. X-ray thoracic and lumbar spine-shows narrowing of L1 vertebral body, probably old injury.
CDC 'Split Type':

Write-up:940 AM found patient on floor with fists lasted approx. 3-5 seconds after patient responsive but c/o headache, dizziness, nausea - BP 122/82 - skin cool and clammy - MD in to check patient c/o of same symptoms but with onset of vomiting - responsive at all times but drowsy - transported to hospital 1030 AM. (when patient fell she hit her head on a cabinet). 05/29/2007 MR received for o/n hospitalization for subdural hematoma. Pt had a vaso-vagal syncopal episode after receiving vax, which resulted in a fall where pt. hit head. (+) LOC and seizure. PE: (+) for occipital tenderness. Not oriented to date. T4-L5 tenderness. Final DX: Head injury. L Parietal-frontal SDH.


Changed on 9/14/2017

277122 Before After
VAERS Form:(blank) 1
Age:17.0
Gender:Female
Location:New Jersey
Vaccinated:2007-04-10
Onset:2007-04-10
Submitted:2007-04-12
Entered:2007-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0250U / 0 1 RA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 0 1 LA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR 4214AA / 0 1 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Cold sweat, Computerised tomogram abnormal, Dizziness, Fall, Head injury, Headache, Nausea, Somnolence, Vomiting

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:
Current Illness: Migraines
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: CT scan - small subdural hematoma (when patient fell she hit her head on a cabinet). Labs and Diagnostics: CT head reveals acute L frontal, parietal, and temporal SDH with midline shift. X-ray cervical spine-mild reversal of kyphosis at C6-C7 likely related to positioning or muscle spasm. X-ray Skull-no abnormality. X-ray thoracic and lumbar spine-shows narrowing of L1 vertebral body, probably old injury.
CDC 'Split Type':

Write-up:940 AM found patient on floor with fists lasted approx. 3-5 seconds after patient responsive but c/o headache, dizziness, nausea - BP 122/82 - skin cool and clammy - MD in to check patient c/o of same symptoms but with onset of vomiting - responsive at all times but drowsy - transported to hospital 1030 AM. (when patient fell she hit her head on a cabinet). 05/29/2007 MR received for o/n hospitalization for subdural hematoma. Pt had a vaso-vagal syncopal episode after receiving vax, which resulted in a fall where pt. hit head. (+) LOC and seizure. PE: (+) for occipital tenderness. Not oriented to date. T4-L5 tenderness. Final DX: Head injury. L Parietal-frontal SDH.


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