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This is VAERS ID 280849

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

280849
VAERS Form:
Age:13.0
Gender:Female
Location:Arizona
Vaccinated:2007-06-01
Onset:2007-06-01
Submitted:2007-06-01
Entered:2007-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1280F / 0 LA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1424F / 0 RA / -
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2115AA / 0 RA / -
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B013AA / 0 LA / -

Administered by: Private      Purchased by: Unknown
Symptoms: Electrocardiogram, Fall, 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:
Preexisting Conditions: Recurrent syncope episodes
Allergies:
Diagnostic Lab Data: EKG
CDC 'Split Type':

Write-up:After giving last immunization. Pt was asked how she felt fine. 2-3 min later asked her again, she said fine. She then fell back on the bed and fainted. Doctor called into the room to examine patient. Pt reacted 2-3 min later.


Changed on 12/8/2009

280849 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Arizona
Vaccinated:2007-06-01
Onset:2007-06-01
Submitted:2007-06-01
Entered:2007-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1280F / 0 LA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1424F / 0 RA / -
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2115AA / 0 RA / -
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B013AA / 0 LA / -

Administered by: Private      Purchased by: Unknown Public
Symptoms: Electrocardiogram, Fall, 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:
Preexisting Conditions: Recurrent syncope episodes
Allergies:
Diagnostic Lab Data: EKG
CDC 'Split Type':

Write-up:After giving last immunization. Pt was asked how she felt fine. 2-3 min later asked her again, she said fine. She then fell back on the bed and fainted. Doctor called into the room to examine patient. Pt reacted 2-3 min later.


Changed on 4/7/2010

280849 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Arizona
Vaccinated:2007-06-01
Onset:2007-06-01
Submitted:2007-06-01
Entered:2007-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1280F / 0 LA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1424F / 0 RA / -
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2115AA / 0 RA / -
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B013AA / 0 LA / -

Administered by: Private      Purchased by: Public
Symptoms: Electrocardiogram, Fall, 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:
Preexisting Conditions: Recurrent syncope episodes
Allergies:
Diagnostic Lab Data: EKG
CDC 'Split Type':

Write-up:After giving last immunization. Pt was asked how she felt fine. 2-3 min later asked her again, she said fine. She then fell back on the bed and fainted. Doctor called into the room to examine patient. Pt reacted 2-3 min later.


Changed on 9/14/2017

280849 Before After
VAERS Form:(blank) 1
Age:13.0
Gender:Female
Location:Arizona
Vaccinated:2007-06-01
Onset:2007-06-01
Submitted:2007-06-01
Entered:2007-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1280F / 0 1 LA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1424F / 0 1 RA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2115AA / 0 1 RA / -
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B013AA / 0 1 LA / -

Administered by: Private      Purchased by: Public
Symptoms: Electrocardiogram, Fall, 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:
Preexisting Conditions: Recurrent syncope episodes
Allergies:
Diagnostic Lab Data: EKG
CDC 'Split Type':

Write-up:After giving last immunization. Pt was asked how she felt fine. 2-3 min later asked her again, she said fine. She then fell back on the bed and fainted. Doctor called into the room to examine patient. Pt reacted 2-3 min later.


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