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This is VAERS ID 277309

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

277309
VAERS Form:
Age:13.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-11
Onset:2007-04-11
Submitted:2007-04-12
Entered:2007-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB148AA / 1 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR U1908AA / 0 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1148F / 1 LA / SC

Administered by: Private      Purchased by: Unknown
Symptoms: Blood pressure normal, Dizziness, Hypotonia, Loss of consciousness, Muscle rigidity

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: O2 Sat 98%, BP 102/78
CDC 'Split Type':

Write-up:After vaccine was given pt stated /"she felt like she was going to pass out/" she turned pale and rigid and lost conscious for about 1 min and when she came to she had post ictal s/s of a blank stare for about 5-10 sec and no response. Pt did walk back to"a room without much time, when she got back to the room she became /"limp/" and needed to be lifted onto a tablet. Went home A+o x ''''53


Changed on 12/8/2009

277309 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-11
Onset:2007-04-11
Submitted:2007-04-12
Entered:2007-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB148AA / 1 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR U1908AA / 0 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1148F / 1 LA / SC

Administered by: Private      Purchased by: Unknown Private
Symptoms: Blood pressure normal, Dizziness, Hypotonia, Loss of consciousness, Muscle rigidity, Oxygen saturation normal, Pallor, Staring, Postictal state

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: O2 Sat 98%, BP 102/78
CDC 'Split Type':

Write-up:After vaccine was given pt stated /"she "she felt like she was going to pass out/" out" she turned pale and rigid and lost conscious for about 1 min and when she came to she had post ictal s/s of a blank stare for about 5-10 sec and no response. Pt did walk back to"a to a room without much time, when she got back to the room she became /"limp/" "limp" and needed to be lifted onto a tablet. Went home A+o x ''''53 ''53


Changed on 4/7/2010

277309 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-11
Onset:2007-04-11
Submitted:2007-04-12
Entered:2007-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB148AA / 1 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U1908AA / 0 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1148F / 1 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Blood pressure normal, Dizziness, Hypotonia, Loss of consciousness, Muscle rigidity, Oxygen saturation normal, Pallor, Staring, Postictal state

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: O2 Sat 98%, BP 102/78
CDC 'Split Type':

Write-up:After vaccine was given pt stated "she felt like she was going to pass out" she turned pale and rigid and lost conscious for about 1 min and when she came to she had post ictal s/s of a blank stare for about 5-10 sec and no response. Pt did walk back to a room without much time, when she got back to the room she became "limp" and needed to be lifted onto a tablet. Went home A+o x ''53


Changed on 5/14/2017

277309 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-11
Onset:2007-04-11
Submitted:2007-04-12
Entered:2007-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB148AA / 1 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U1908AA / 0 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1148F / 1 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Blood pressure normal, Dizziness, Hypotonia, Loss of consciousness, Muscle rigidity, Oxygen saturation normal, Pallor, Staring, Postictal state

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: O2 Sat 98%, BP 102/78
CDC 'Split Type':

Write-up:After vaccine was given pt stated "she felt like she was going to pass out" she turned pale and rigid and lost conscious for about 1 min and when she came to she had post ictal s/s of a blank stare for about 5-10 sec and no response. Pt did walk back to a room without much time, when she got back to the room she became "limp" and needed to be lifted onto a tablet. Went home A+o x ''53


Changed on 9/14/2017

277309 Before After
VAERS Form:(blank) 1
Age:13.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-11
Onset:2007-04-11
Submitted:2007-04-12
Entered:2007-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB148AA / 1 2 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 0 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1908AA / 0 1 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1148F / 1 2 LA / SC

Administered by: Private      Purchased by: Private
Symptoms: Blood pressure normal, Dizziness, Hypotonia, Loss of consciousness, Muscle rigidity, Oxygen saturation normal, Pallor, Staring, Postictal state

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: O2 Sat 98%, BP 102/78
CDC 'Split Type':

Write-up:After vaccine was given pt stated "she felt like she was going to pass out" she turned pale and rigid and lost conscious for about 1 min and when she came to she had post ictal s/s of a blank stare for about 5-10 sec and no response. Pt did walk back to a room without much time, when she got back to the room she became "limp" and needed to be lifted onto a tablet. Went home A+o x ''53


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