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This is VAERS ID 279600

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

279600
VAERS Form:
Age:16.0
Gender:Female
Location:Florida
Vaccinated:2007-05-22
Onset:2007-05-22
Submitted:2007-05-23
Entered:2007-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0954F / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2136AA / 0 RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Dyskinesia, Syncope

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:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up:Pt has syncope and had jerky movement for a minute. Patients legs were elevated and monitored. Pt recovered after 45 min.


Changed on 12/8/2009

279600 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Florida
Vaccinated:2007-05-22
Onset:2007-05-22
Submitted:2007-05-23
Entered:2007-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0954F / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2136AA / 0 RA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Dyskinesia, Syncope

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:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up:Pt has syncope and had jerky movement for a minute. Patients legs were elevated and monitored. Pt recovered after 45 min.


Changed on 4/7/2010

279600 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Florida
Vaccinated:2007-05-22
Onset:2007-05-22
Submitted:2007-05-23
Entered:2007-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0954F / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2136AA / 0 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Dyskinesia, Syncope

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:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up:Pt has syncope and had jerky movement for a minute. Patients legs were elevated and monitored. Pt recovered after 45 min.


Changed on 9/14/2017

279600 Before After
VAERS Form:(blank) 1
Age:16.0
Gender:Female
Location:Florida
Vaccinated:2007-05-22
Onset:2007-05-22
Submitted:2007-05-23
Entered:2007-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0954F / 0 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2136AA / 0 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Dyskinesia, Syncope

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:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up:Pt has syncope and had jerky movement for a minute. Patients legs were elevated and monitored. Pt recovered after 45 min.


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