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This is VAERS ID 279017

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

279017
VAERS Form:
Age:16.0
Gender:Female
Location:Washington
Vaccinated:2007-05-16
Onset:2007-05-16
Submitted:2007-05-18
Entered:2007-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0246U / 0 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0171U / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2223AA / 0 GM / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B015BA / 0 RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Grand mal convulsion, Loss of consciousness

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness: pt. complained of dizziness for last 5 days
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:A few seconds after the vaccines were administered the pt. passed out and then had tonic clonic seizure lasting approx. 1 minute.


Changed on 12/8/2009

279017 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Washington
Vaccinated:2007-05-16
Onset:2007-05-16
Submitted:2007-05-18
Entered:2007-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0246U / 0 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0171U / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2223AA / 0 GM / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B015BA / 0 RA / IM

Administered by: Private      Purchased by: Unknown Public
Symptoms: Grand mal convulsion, Loss of consciousness

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness: pt. complained of dizziness for last 5 days
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:A few seconds after the vaccines were administered the pt. passed out and then had tonic clonic seizure lasting approx. 1 minute.


Changed on 4/7/2010

279017 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Washington
Vaccinated:2007-05-16
Onset:2007-05-16
Submitted:2007-05-18
Entered:2007-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0246U / 0 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0171U / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2223AA / 0 GM / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B015BA / 0 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Grand mal convulsion, Loss of consciousness

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness: pt. complained of dizziness for last 5 days
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:A few seconds after the vaccines were administered the pt. passed out and then had tonic clonic seizure lasting approx. 1 minute.


Changed on 9/14/2017

279017 Before After
VAERS Form:(blank) 1
Age:16.0
Gender:Female
Location:Washington
Vaccinated:2007-05-16
Onset:2007-05-16
Submitted:2007-05-18
Entered:2007-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0246U / 0 1 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0171U / 0 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2223AA / 0 1 GM / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B015BA / 0 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Grand mal convulsion, Loss of consciousness

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness: pt. complained of dizziness for last 5 days
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:A few seconds after the vaccines were administered the pt. passed out and then had tonic clonic seizure lasting approx. 1 minute.


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