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This is VAERS ID 284288

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

284288
VAERS Form:
Age:17.0
Gender:Female
Location:Michigan
Vaccinated:2007-07-11
Onset:2007-07-11
Submitted:2007-07-11
Entered:2007-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. C2638AA / - - / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR AVU2277AA / - - / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR 1208F / - - / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Cold sweat, Dyskinesia, Pallor, Gaze palsy, Immediate post-injection reaction

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:
CDC 'Split Type':

Write-up:Immed. after receiving injection client eyes rolled and tongue protruded (siezure like activity)became VERY pale and fainted. Skin was cold and clammy. Took several minutes for her to come around. Client had 2 injection prior to getting the HPV.


Changed on 12/8/2009

284288 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Michigan
Vaccinated:2007-07-11
Onset:2007-07-11
Submitted:2007-07-11
Entered:2007-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. C2638AA / - - / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR AVU2277AA / - - / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR 1208F / - - / IM

Administered by: Public      Purchased by: Unknown Public
Symptoms: Cold sweat, Dyskinesia, Pallor, Peripheral coldness, Syncope, Gaze palsy, Immediate post-injection reaction

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:
CDC 'Split Type':

Write-up:Immed. after receiving injection client eyes rolled and tongue protruded (siezure like activity)became VERY pale and fainted. Skin was cold and clammy. Took several minutes for her to come around. Client had 2 injection prior to getting the HPV.


Changed on 4/7/2010

284288 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Michigan
Vaccinated:2007-07-11
Onset:2007-07-11
Submitted:2007-07-11
Entered:2007-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. C2638AA / - - / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR AVU2277AA / - - / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR 1208F / - - / IM

Administered by: Public      Purchased by: Public
Symptoms: Cold sweat, Dyskinesia, Pallor, Peripheral coldness, Syncope, Gaze palsy, Immediate post-injection reaction

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:
CDC 'Split Type':

Write-up:Immed. after receiving injection client eyes rolled and tongue protruded (siezure like activity)became VERY pale and fainted. Skin was cold and clammy. Took several minutes for her to come around. Client had 2 injection prior to getting the HPV.


Changed on 9/14/2017

284288 Before After
VAERS Form:(blank) 1
Age:17.0
Gender:Female
Location:Michigan
Vaccinated:2007-07-11
Onset:2007-07-11
Submitted:2007-07-11
Entered:2007-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. C2638AA / - UNK - / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR AVU2277AA / - UNK - / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR 1208F / - UNK - / IM

Administered by: Public      Purchased by: Public
Symptoms: Cold sweat, Dyskinesia, Pallor, Peripheral coldness, Syncope, Gaze palsy, Immediate post-injection reaction

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:
CDC 'Split Type':

Write-up:Immed. after receiving injection client eyes rolled and tongue protruded (siezure like activity)became VERY pale and fainted. Skin was cold and clammy. Took several minutes for her to come around. Client had 2 injection prior to getting the HPV.


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