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This is VAERS ID 282769

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

282769
VAERS Form:
Age:17.0
Gender:Female
Location:Virginia
Vaccinated:2007-06-18
Onset:2007-06-18
Submitted:2007-06-22
Entered:2007-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0384U / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2234AA / 0 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C264AA / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Blood pressure decreased, Dizziness, Fall, Heart rate decreased, Hyperhidrosis

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:
CDC 'Split Type':

Write-up:Became lightheaded, fell backwards and caught by mom. Placed on exam table where she became diaphoretic, pale, BP decrease 50/36, HR 40. Given fluids, Recovered after 15 minutes, Hct 13.5, VS stable after 1/2 hr.


Changed on 12/8/2009

282769 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Virginia
Vaccinated:2007-06-18
Onset:2007-06-18
Submitted:2007-06-22
Entered:2007-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0384U / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2234AA / 0 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C264AA / 0 LA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Blood pressure decreased, Dizziness, Fall, Heart rate decreased, Hyperhidrosis, 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Became lightheaded, fell backwards and caught by mom. Placed on exam table where she became diaphoretic, pale, BP decrease 50/36, HR 40. Given fluids, Recovered after 15 minutes, Hct 13.5, VS stable after 1/2 hr.


Changed on 4/7/2010

282769 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Virginia
Vaccinated:2007-06-18
Onset:2007-06-18
Submitted:2007-06-22
Entered:2007-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0384U / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2234AA / 0 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C264AA / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Blood pressure decreased, Dizziness, Fall, Heart rate decreased, Hyperhidrosis, 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Became lightheaded, fell backwards and caught by mom. Placed on exam table where she became diaphoretic, pale, BP decrease 50/36, HR 40. Given fluids, Recovered after 15 minutes, Hct 13.5, VS stable after 1/2 hr.


Changed on 9/14/2017

282769 Before After
VAERS Form:(blank) 1
Age:17.0
Gender:Female
Location:Virginia
Vaccinated:2007-06-18
Onset:2007-06-18
Submitted:2007-06-22
Entered:2007-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0384U / 0 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2234AA / 0 1 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C264AA / 0 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Blood pressure decreased, Dizziness, Fall, Heart rate decreased, Hyperhidrosis, 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Became lightheaded, fell backwards and caught by mom. Placed on exam table where she became diaphoretic, pale, BP decrease 50/36, HR 40. Given fluids, Recovered after 15 minutes, Hct 13.5, VS stable after 1/2 hr.


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