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This is VAERS ID 284127

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

284127
VAERS Form:
Age:
Gender:Female
Location:Unknown
Vaccinated:2007-05-14
Onset:2007-05-14
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / UN
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR - / - UN / UN

Administered by: Other      Purchased by: Other
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)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0705USA03133

Write-up:Information has been received from a licensed visiting nurse, via a company representative, concerning a female student in twelfth grade, who on 14-MAY-2007 was vaccinated at a high school health fair, with the first dose, 0.5ml of Gardasil. Concomitant therapy included MENACTRA. The nurse reported that after receiving the vaccination, the student fainted, and was then taken to her private physician by her parents. The nurse confirmed that the student recovered on the same day, 14-MAY-2007. No further information is expected.


Changed on 4/7/2010

284127 Before After
VAERS Form:
Age:
Gender:Female
Location:Unknown
Vaccinated:2007-05-14
Onset:2007-05-14
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / UN
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / - UN / UN

Administered by: Other      Purchased by: Other
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)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0705USA03133

Write-up:Information has been received from a licensed visiting nurse, via a company representative, concerning a female student in twelfth grade, who on 14-MAY-2007 was vaccinated at a high school health fair, with the first dose, 0.5ml of Gardasil. Concomitant therapy included MENACTRA. The nurse reported that after receiving the vaccination, the student fainted, and was then taken to her private physician by her parents. The nurse confirmed that the student recovered on the same day, 14-MAY-2007. No further information is expected.


Changed on 9/14/2017

284127 Before After
VAERS Form:(blank) 1
Age:
Gender:Female
Location:Unknown
Vaccinated:2007-05-14
Onset:2007-05-14
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 1 UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / - UNK UN / UN

Administered by: Other      Purchased by: Other
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)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0705USA03133

Write-up:Information has been received from a licensed visiting nurse, via a company representative, concerning a female student in twelfth grade, who on 14-MAY-2007 was vaccinated at a high school health fair, with the first dose, 0.5ml of Gardasil. Concomitant therapy included MENACTRA. The nurse reported that after receiving the vaccination, the student fainted, and was then taken to her private physician by her parents. The nurse confirmed that the student recovered on the same day, 14-MAY-2007. No further information is expected.


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