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This is VAERS ID 282822

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

282822
VAERS Form:
Age:15.0
Gender:Female
Location:Wisconsin
Vaccinated:2007-06-15
Onset:2007-06-15
Submitted:2007-06-25
Entered:2007-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0522U / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2228AA / 0 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0336U / 0 RA / SC

Administered by: Private      Purchased by: Unknown
Symptoms: 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: None
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Patient has a very small stature. She is 15.5 years old and is 4ft 10.5 inches and weighs 76 pounds.
CDC 'Split Type':

Write-up:She received 3 vaccines, the last of which was HPV. After the third vaccination, she had a syncopal episode and it took approximately 3 minutes to regain consciousness. She was mentally alert and feeling fine by the time she left the clinic 15 minutes l"ater. We elevated her feet and gave her something to drink.


Changed on 12/8/2009

282822 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Wisconsin
Vaccinated:2007-06-15
Onset:2007-06-15
Submitted:2007-06-25
Entered:2007-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0522U / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2228AA / 0 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0336U / 0 RA / SC

Administered by: Private      Purchased by: Unknown
Symptoms: 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: None
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Patient has a very small stature. She is 15.5 years old and is 4ft 10.5 inches and weighs 76 pounds.
CDC 'Split Type':

Write-up:She received 3 vaccines, the last of which was HPV. After the third vaccination, she had a syncopal episode and it took approximately 3 minutes to regain consciousness. She was mentally alert and feeling fine by the time she left the clinic 15 minutes l"ater. later. We elevated her feet and gave her something to drink.


Changed on 4/7/2010

282822 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Wisconsin
Vaccinated:2007-06-15
Onset:2007-06-15
Submitted:2007-06-25
Entered:2007-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0522U / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2228AA / 0 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0336U / 0 RA / SC

Administered by: Private      Purchased by: Unknown
Symptoms: 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: None
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Patient has a very small stature. She is 15.5 years old and is 4ft 10.5 inches and weighs 76 pounds.
CDC 'Split Type':

Write-up:She received 3 vaccines, the last of which was HPV. After the third vaccination, she had a syncopal episode and it took approximately 3 minutes to regain consciousness. She was mentally alert and feeling fine by the time she left the clinic 15 minutes later. We elevated her feet and gave her something to drink.


Changed on 9/14/2017

282822 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:Wisconsin
Vaccinated:2007-06-15
Onset:2007-06-15
Submitted:2007-06-25
Entered:2007-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0522U / 0 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2228AA / 0 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0336U / 0 1 RA / SC

Administered by: Private      Purchased by: Unknown
Symptoms: 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: None
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Patient has a very small stature. She is 15.5 years old and is 4ft 10.5 inches and weighs 76 pounds.
CDC 'Split Type':

Write-up:She received 3 vaccines, the last of which was HPV. After the third vaccination, she had a syncopal episode and it took approximately 3 minutes to regain consciousness. She was mentally alert and feeling fine by the time she left the clinic 15 minutes later. We elevated her feet and gave her something to drink.


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