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This is VAERS ID 283857

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

283857
VAERS Form:
Age:15.0
Gender:Female
Location:Massachusetts
Vaccinated:2007-06-29
Onset:2007-06-29
Submitted:2007-07-02
Entered:2007-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0524V / 0 RA / -
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2720 / 0 LA / -

Administered by: Private      Purchased by: Unknown
Symptoms: Hyperhidrosis, 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Pt became pale, diaphoretic, after vaccine administered was given, sitting down, had not eaten all day BP 102/68 - 112/80 O2 98-100%.


Changed on 12/8/2009

283857 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Massachusetts
Vaccinated:2007-06-29
Onset:2007-06-29
Submitted:2007-07-02
Entered:2007-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0524V / 0 RA / -
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2720 / 0 LA / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Hyperhidrosis, 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Pt became pale, diaphoretic, after vaccine administered was given, sitting down, had not eaten all day BP 102/68 - 112/80 O2 98-100%.


Changed on 9/14/2017

283857 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:Massachusetts
Vaccinated:2007-06-29
Onset:2007-06-29
Submitted:2007-07-02
Entered:2007-07-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0524V / 0 1 RA / -
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2720 / 0 1 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Hyperhidrosis, 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Pt became pale, diaphoretic, after vaccine administered was given, sitting down, had not eaten all day BP 102/68 - 112/80 O2 98-100%.


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