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This is VAERS ID 280470

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

280470
VAERS Form:
Age:12.0
Gender:Female
Location:Idaho
Vaccinated:2007-06-04
Onset:2007-06-04
Submitted:2007-06-05
Entered:2007-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0384U / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2170AA / 0 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B014AA / 0 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1049F / 0 LA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Convulsion, Fall, Malaise, Pallor

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: NONE
Current Illness: No illness at time of vaccination
Preexisting Conditions: amoxicillin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Client received vaccines, has passed out before from immunizations mother reported. After receiving vaccines client turned a little pale, client was laid down on a bed and given apple juice to drink. She stayed down for approximately 10 minutes, then mo"ther and daughter left, stating that she was feeling fine.More than 20 minutes after vaccination, Client returned to clinic with mother and sister to have sister receive vaccinations. Client stated that she didn''''t feel well and laid down on the chairs i


Changed on 12/8/2009

280470 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Idaho
Vaccinated:2007-06-04
Onset:2007-06-04
Submitted:2007-06-05
Entered:2007-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0384U / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2170AA / 0 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B014AA / 0 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1049F / 0 LA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Convulsion, Fall, Malaise, Pallor

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: NONE
Current Illness: No illness at time of vaccination
Preexisting Conditions: amoxicillin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Client received vaccines, has passed out before from immunizations mother reported. After receiving vaccines client turned a little pale, client was laid down on a bed and given apple juice to drink. She stayed down for approximately 10 minutes, then mo"ther mother and daughter left, stating that she was feeling fine.More than 20 minutes after vaccination, Client returned to clinic with mother and sister to have sister receive vaccinations. Client stated that she didn''''t didn''t feel well and laid down on the chairs i in waiting area. She mumbled something to mother and had a seizure and rolled off the chairs she was laying on. Mother caught her and eased her to the floor. The seizure lasted less than a minute. Offer to call an ambulance was refused. Cold cloth was applied to forehead and arms. Mother was encouraged to take her to the doctor. Mother was called 06-05-07 am, mother stated that Kendra had a doctors appointment today to be seen. She stated that she was acting normal today and that she would call if the doctor stated anything wrong.


Changed on 4/7/2010

280470 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Idaho
Vaccinated:2007-06-04
Onset:2007-06-04
Submitted:2007-06-05
Entered:2007-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0384U / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2170AA / 0 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B014AA / 0 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1049F / 0 LA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Convulsion, Fall, Malaise, Pallor

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: NONE
Current Illness: No illness at time of vaccination
Preexisting Conditions: amoxicillin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Client received vaccines, has passed out before from immunizations mother reported. After receiving vaccines client turned a little pale, client was laid down on a bed and given apple juice to drink. She stayed down for approximately 10 minutes, then mother and daughter left, stating that she was feeling fine.More than 20 minutes after vaccination, Client returned to clinic with mother and sister to have sister receive vaccinations. Client stated that she didn''t feel well and laid down on the chairs in waiting area. She mumbled something to mother and had a seizure and rolled off the chairs she was laying on. Mother caught her and eased her to the floor. The seizure lasted less than a minute. Offer to call an ambulance was refused. Cold cloth was applied to forehead and arms. Mother was encouraged to take her to the doctor. Mother was called 06-05-07 am, mother stated that Kendra had a doctors appointment today to be seen. She stated that she was acting normal today and that she would call if the doctor stated anything wrong.


Changed on 1/7/2013

280470 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Idaho
Vaccinated:2007-06-04
Onset:2007-06-04
Submitted:2007-06-05
Entered:2007-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0384U / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2170AA / 0 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B014AA / 0 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1049F / 0 LA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Convulsion, Fall, Malaise, Pallor

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: NONE
Current Illness: No illness at time of vaccination
Preexisting Conditions: amoxicillin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Client received vaccines, has passed out before from immunizations mother reported. After receiving vaccines client turned a little pale, client was laid down on a bed and given apple juice to drink. She stayed down for approximately 10 minutes, then mother and daughter left, stating that she was feeling fine.More than 20 minutes after vaccination, Client returned to clinic with mother and sister to have sister receive vaccinations. Client stated that she didn''t feel well and laid down on the chairs in waiting area. She mumbled something to mother and had a seizure and rolled off the chairs she was laying on. Mother caught her and eased her to the floor. The seizure lasted less than a minute. Offer to call an ambulance was refused. Cold cloth was applied to forehead and arms. Mother was encouraged to take her to the doctor. Mother was called 06-05-07 am, mother stated that Kendra patient had a doctors appointment today to be seen. She stated that she was acting normal today and that she would call if the doctor stated anything wrong.


Changed on 6/14/2014

280470 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Idaho
Vaccinated:2007-06-04
Onset:2007-06-04
Submitted:2007-06-05
Entered:2007-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0384U / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2170AA / 0 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B014AA / 0 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1049F / 0 LA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Convulsion, Fall, Malaise, Pallor

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: NONE
Current Illness: No illness at time of vaccination
Preexisting Conditions: amoxicillin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Client received vaccines, has passed out before from immunizations mother reported. After receiving vaccines client turned a little pale, client was laid down on a bed and given apple juice to drink. She stayed down for approximately 10 minutes, then mother and daughter left, stating that she was feeling fine.More than 20 minutes after vaccination, Client returned to clinic with mother and sister to have sister receive vaccinations. Client stated that she didn''t feel well and laid down on the chairs in waiting area. She mumbled something to mother and had a seizure and rolled off the chairs she was laying on. Mother caught her and eased her to the floor. The seizure lasted less than a minute. Offer to call an ambulance was refused. Cold cloth was applied to forehead and arms. Mother was encouraged to take her to the doctor. Mother was called 06-05-07 am, mother stated that patient had a doctors appointment today to be seen. She stated that she was acting normal today and that she would call if the doctor stated anything wrong.


Changed on 3/14/2015

280470 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Idaho
Vaccinated:2007-06-04
Onset:2007-06-04
Submitted:2007-06-05
Entered:2007-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0384U / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2170AA / 0 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B014AA / 0 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1049F / 0 LA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Convulsion, Fall, Malaise, Pallor

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: NONE
Current Illness: No illness at time of vaccination
Preexisting Conditions: amoxicillin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Client received vaccines, has passed out before from immunizations mother reported. After receiving vaccines client turned a little pale, client was laid down on a bed and given apple juice to drink. She stayed down for approximately 10 minutes, then mother and daughter left, stating that she was feeling fine.More than 20 minutes after vaccination, Client returned to clinic with mother and sister to have sister receive vaccinations. Client stated that she didn''t feel well and laid down on the chairs in waiting area. She mumbled something to mother and had a seizure and rolled off the chairs she was laying on. Mother caught her and eased her to the floor. The seizure lasted less than a minute. Offer to call an ambulance was refused. Cold cloth was applied to forehead and arms. Mother was encouraged to take her to the doctor. Mother was called 06-05-07 am, mother stated that patient had a doctors appointment today to be seen. She stated that she was acting normal today and that she would call if the doctor stated anything wrong.


Changed on 9/14/2017

280470 Before After
VAERS Form:(blank) 1
Age:12.0
Gender:Female
Location:Idaho
Vaccinated:2007-06-04
Onset:2007-06-04
Submitted:2007-06-05
Entered:2007-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0384U / 0 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2170AA / 0 1 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B014AA / 0 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1049F / 0 1 LA / SC

Administered by: Unknown      Purchased by: Unknown
Symptoms: Convulsion, Fall, Malaise, Pallor

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: NONE
Current Illness: No illness at time of vaccination
Preexisting Conditions: amoxicillin
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Client received vaccines, has passed out before from immunizations mother reported. After receiving vaccines client turned a little pale, client was laid down on a bed and given apple juice to drink. She stayed down for approximately 10 minutes, then mother and daughter left, stating that she was feeling fine.More than 20 minutes after vaccination, Client returned to clinic with mother and sister to have sister receive vaccinations. Client stated that she didn''t feel well and laid down on the chairs in waiting area. She mumbled something to mother and had a seizure and rolled off the chairs she was laying on. Mother caught her and eased her to the floor. The seizure lasted less than a minute. Offer to call an ambulance was refused. Cold cloth was applied to forehead and arms. Mother was encouraged to take her to the doctor. Mother was called 06-05-07 am, mother stated that patient had a doctors appointment today to be seen. She stated that she was acting normal today and that she would call if the doctor stated anything wrong.


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