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This is VAERS ID 284237

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

284237
VAERS Form:
Age:16.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-07-10
Onset:2007-07-10
Submitted:2007-07-10
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0387U / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2365AA / 2 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B018AD / 0 RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Convulsion, Fall, Injury, Syncope vasovagal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Pt. had a vasovagal response to Gardasil vaccine in the office, falling onto the floor and hitting her face. Pt had seizure activity, per her mother. Pt was moved to a chair, was sitting and talking and went on to have further seizure acitivty and 911 was"called. we monitered the pt. until medics arrived and she was transported to the ED.


Changed on 12/8/2009

284237 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-07-10
Onset:2007-07-10
Submitted:2007-07-10
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0387U / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2365AA / 2 0 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B018AD / 0 RA / IM

Administered by: Private Unknown      Purchased by: Unknown
Symptoms: Convulsion, Fall, Injury, Syncope vasovagal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Pt. had a vasovagal response to Gardasil vaccine in the office, falling onto the floor and hitting her face. Pt had seizure activity, per her mother. Pt was moved to a chair, was sitting and talking and went on to have further seizure acitivty and 911 was"called. was called. we monitered the pt. until medics arrived and she was transported to the ED.


Changed on 4/7/2010

284237 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-07-10
Onset:2007-07-10
Submitted:2007-07-10
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0387U / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2365AA / 0 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B018AD / 0 RA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Convulsion, Fall, Injury, Syncope vasovagal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Pt. had a vasovagal response to Gardasil vaccine in the office, falling onto the floor and hitting her face. Pt had seizure activity, per her mother. Pt was moved to a chair, was sitting and talking and went on to have further seizure acitivty and 911 was called. we monitered the pt. until medics arrived and she was transported to the ED.


Changed on 6/14/2014

284237 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-07-10
Onset:2007-07-10
Submitted:2007-07-10
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0387U / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2365AA / 0 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B018AD / 0 RA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Convulsion, Fall, Injury, Syncope vasovagal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Pt. had a vasovagal response to Gardasil vaccine in the office, falling onto the floor and hitting her face. Pt had seizure activity, per her mother. Pt was moved to a chair, was sitting and talking and went on to have further seizure acitivty and 911 was called. we monitered the pt. until medics arrived and she was transported to the ED.


Changed on 5/14/2017

284237 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-07-10
Onset:2007-07-10
Submitted:2007-07-10
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0387U / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2365AA / 0 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B018AD / 0 RA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Convulsion, Fall, Injury, Syncope vasovagal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Pt. had a vasovagal response to Gardasil vaccine in the office, falling onto the floor and hitting her face. Pt had seizure activity, per her mother. Pt was moved to a chair, was sitting and talking and went on to have further seizure acitivty and 911 was called. we monitered the pt. until medics arrived and she was transported to the ED.


Changed on 9/14/2017

284237 Before After
VAERS Form:(blank) 1
Age:16.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-07-10
Onset:2007-07-10
Submitted:2007-07-10
Entered:2007-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0387U / 0 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2365AA / 0 1 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B018AD / 0 1 RA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Convulsion, Fall, Injury, Syncope vasovagal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Pt. had a vasovagal response to Gardasil vaccine in the office, falling onto the floor and hitting her face. Pt had seizure activity, per her mother. Pt was moved to a chair, was sitting and talking and went on to have further seizure acitivty and 911 was called. we monitered the pt. until medics arrived and she was transported to the ED.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=284237&WAYBACKHISTORY=ON


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