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This is VAERS ID 279313

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

279313
VAERS Form:
Age:15.0
Gender:Female
Location:Missouri
Vaccinated:2007-05-07
Onset:2007-05-07
Submitted:2007-05-16
Entered:2007-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0389U / - RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2228AA / - LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Fall, Loss of consciousness, Unresponsive to stimuli

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:
Preexisting Conditions: The patient had no illness at the time of vaccination and had no known pre-existing medical conditions.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Initial report received on 10 May 2007 from a health care professional. A 15-year-old female patient, with no known past medical history, had received a left deltoid, intramuscular injection of Menactra, lot number U2228AA; and a right deltoid, intramuscu"lar injection of Gardasil, lot number 0389U; on 07 May 2007. On the same day following vaccination, the patient /"passed out/" and fell to the floor. She was unresponsive for approximately 40 seconds. The patient did not experience any respiratory distres


Changed on 12/8/2009

279313 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Missouri
Vaccinated:2007-05-07
Onset:2007-05-07
Submitted:2007-05-16
Entered:2007-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0389U / - RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2228AA / - LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Fall, Loss of consciousness, Unresponsive to stimuli

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:
Preexisting Conditions: The patient had no illness at the time of vaccination and had no known pre-existing medical conditions.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 200701717

Write-up:Initial report received on 10 May 2007 from a health care professional. A 15-year-old female patient, with no known past medical history, had received a left deltoid, intramuscular injection of Menactra, lot number U2228AA; and a right deltoid, intramuscu"lar intramuscular injection of Gardasil, lot number 0389U; on 07 May 2007. On the same day following vaccination, the patient /"passed out/" "passed out" and fell to the floor. She was unresponsive for approximately 40 seconds. The patient did not experience any respiratory distres distress, and the event fully resolved without medical intervention.


Changed on 4/7/2010

279313 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Missouri
Vaccinated:2007-05-07
Onset:2007-05-07
Submitted:2007-05-16
Entered:2007-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0389U / - RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2228AA / - LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Fall, Loss of consciousness, Unresponsive to stimuli

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:
Preexisting Conditions: The patient had no illness at the time of vaccination and had no known pre-existing medical conditions.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 200701717

Write-up:Initial report received on 10 May 2007 from a health care professional. A 15-year-old female patient, with no known past medical history, had received a left deltoid, intramuscular injection of Menactra, lot number U2228AA; and a right deltoid, intramuscular injection of Gardasil, lot number 0389U; on 07 May 2007. On the same day following vaccination, the patient "passed out" and fell to the floor. She was unresponsive for approximately 40 seconds. The patient did not experience any respiratory distress, and the event fully resolved without medical intervention.


Changed on 9/14/2017

279313 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:Missouri
Vaccinated:2007-05-07
Onset:2007-05-07
Submitted:2007-05-16
Entered:2007-05-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0389U / - UNK RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2228AA / - UNK LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Fall, Loss of consciousness, Unresponsive to stimuli

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:
Preexisting Conditions: The patient had no illness at the time of vaccination and had no known pre-existing medical conditions.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 200701717

Write-up:Initial report received on 10 May 2007 from a health care professional. A 15-year-old female patient, with no known past medical history, had received a left deltoid, intramuscular injection of Menactra, lot number U2228AA; and a right deltoid, intramuscular injection of Gardasil, lot number 0389U; on 07 May 2007. On the same day following vaccination, the patient "passed out" and fell to the floor. She was unresponsive for approximately 40 seconds. The patient did not experience any respiratory distress, and the event fully resolved without medical intervention.


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