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This is VAERS ID 283845

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

283845
VAERS Form:
Age:16.0
Gender:Female
Location:Colorado
Vaccinated:2007-06-27
Onset:2007-06-27
Submitted:2007-06-29
Entered:2007-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0442U / 0 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0524C / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2734AA / 5 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Clonus, Dizziness, Electrocardiogram normal, Full blood count, Head injury

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair, Albuterol
Current Illness:
Preexisting Conditions: Stable exercise induced asthma, Allergic garamycin
Allergies:
Diagnostic Lab Data: CBC WNL, EKG WNL, D-Dimer <.22 WNL
CDC 'Split Type':

Write-up:Within a couple minutes of admin, she verbalized she felt faint, slumped and hit head against exam table mirror, became pale, clonic arm movements x 4 per mom. Administered O2, elevated feet gave water, pretzels. Hypotensive in ER where she was sent with"1 hour in office.


Changed on 12/8/2009

283845 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Colorado
Vaccinated:2007-06-27
Onset:2007-06-27
Submitted:2007-06-29
Entered:2007-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0442U / 0 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0524C / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2734AA / 5 LA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Clonus, Dizziness, Electrocardiogram normal, Full blood count, Head injury, Hypotension, 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)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair, Albuterol
Current Illness:
Preexisting Conditions: Stable exercise induced asthma, Allergic garamycin
Allergies:
Diagnostic Lab Data: CBC WNL, EKG WNL, D-Dimer <.22 WNL
CDC 'Split Type':

Write-up:Within a couple minutes of admin, she verbalized she felt faint, slumped and hit head against exam table mirror, became pale, clonic arm movements x 4 per mom. Administered O2, elevated feet gave water, pretzels. Hypotensive in ER where she was sent with"1 with 1 hour in office.


Changed on 9/14/2017

283845 Before After
VAERS Form:(blank) 1
Age:16.0
Gender:Female
Location:Colorado
Vaccinated:2007-06-27
Onset:2007-06-27
Submitted:2007-06-29
Entered:2007-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0442U / 0 1 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0524C / 0 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2734AA / 5 6 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Clonus, Dizziness, Electrocardiogram normal, Full blood count, Head injury, Hypotension, 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)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: Singulair, Albuterol
Current Illness:
Preexisting Conditions: Stable exercise induced asthma, Allergic garamycin
Allergies:
Diagnostic Lab Data: CBC WNL, EKG WNL, D-Dimer <.22 WNL
CDC 'Split Type':

Write-up:Within a couple minutes of admin, she verbalized she felt faint, slumped and hit head against exam table mirror, became pale, clonic arm movements x 4 per mom. Administered O2, elevated feet gave water, pretzels. Hypotensive in ER where she was sent with 1 hour in office.


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