| VAERS ID: |
282772 (history) |
| Form: |
Version 1.0 |
| Age: |
14.0 |
| Gender: |
Female |
| Location: |
Pennsylvania |
| Vaccinated: | 2007-06-12 |
| Onset: | 2007-06-12 |
| Days after vaccination: | 0 |
| Submitted: |
2007-06-19 |
| Days after onset: | 7 |
| Entered: |
2007-06-25 |
| Days after submission: | 6 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0955F / 1 |
RA / UN |
| MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR |
U2004AA / 1 |
RA / UN |
Administered by: Private Purchased by: Private
Symptoms:
SMQs:
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol PRN, Zyrtec PRN
Current Illness: NONE
Preexisting Conditions: Environmental allergies
Allergies:
Diagnostic Lab Data: Patient also received Menactra vaccine same day 7/11/07-spoke with reporter''s office-patient became dizzy, fell in parking lot-returned to office BP 98/56. Appeared to be vasovagal reaction to immunization. Observed and recovered.
CDC Split Type:
Write-up: None stated | 