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 |