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This is VAERS ID 282772

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

282772
VAERS Form:
Age:14.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-06-12
Onset:2007-06-12
Submitted:2007-06-19
Entered:2007-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 0 RA / UN
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2004AA / 0 RA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Blood pressure decreased, Dizziness, Fall, Syncope vasovagal

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: 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


Changed on 12/8/2009

282772 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-06-12
Onset:2007-06-12
Submitted:2007-06-19
Entered:2007-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 0 RA / UN
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2004AA / 0 RA / UN

Administered by: Private      Purchased by: Unknown Private
Symptoms: Blood pressure decreased, Dizziness, Fall, Syncope vasovagal

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: 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 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


Changed on 4/7/2010

282772 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-06-12
Onset:2007-06-12
Submitted:2007-06-19
Entered:2007-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 0 RA / UN
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2004AA / 0 RA / UN

Administered by: Private      Purchased by: Private
Symptoms: Blood pressure decreased, Dizziness, Fall, Syncope vasovagal

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: 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


Changed on 2/14/2017

282772 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-06-12
Onset:2007-06-12
Submitted:2007-06-19
Entered:2007-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 0 RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2004AA / 0 RA / UN

Administered by: Private      Purchased by: Private
Symptoms: Blood pressure decreased, Dizziness, Fall, Syncope vasovagal

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: 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


Changed on 9/14/2017

282772 Before After
VAERS Form:(blank) 1
Age:14.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-06-12
Onset:2007-06-12
Submitted:2007-06-19
Entered:2007-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 0 1 RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2004AA / 0 1 RA / UN

Administered by: Private      Purchased by: Private
Symptoms:

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: 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


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