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This is VAERS ID 284720

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

284720
VAERS Form:
Age:18.0
Gender:Female
Location:Florida
Vaccinated:2007-06-12
Onset:2007-06-12
Submitted:2007-06-29
Entered:2007-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0523U / 0 UN / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2339AA / 0 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Lip swelling, Oedema peripheral, Pyrexia, Urticaria

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:
Current Illness:
Preexisting Conditions: Scoliosis, spinal fusion (08/Jul/2005)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:A case was reported by a health professional in the United States on 18 June 2007. An 18-year-old female patient experienced hives, swelling of the lip, hands, and feet, and fever after receiving an intramuscular deltoid injection of Menactra (lot number"U2339AA) and Gardasil (lot number 0523U). The vaccines were administered on 12 June 2007, and within 24 hours the patient developed hives, swelling of the lip, hands, and feet, and fever (no documented temperature). Treatment included Benadryl and Tylenol


Changed on 12/8/2009

284720 Before After
VAERS Form:
Age:18.0
Gender:Female
Location:Florida
Vaccinated:2007-06-12
Onset:2007-06-12
Submitted:2007-06-29
Entered:2007-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0523U / 0 UN / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2339AA / 0 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Lip swelling, Oedema peripheral, Pyrexia, Urticaria

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:
Current Illness:
Preexisting Conditions: Scoliosis, spinal fusion (08/Jul/2005)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 200702231

Write-up:A case was reported by a health professional in the United States on 18 June 2007. An 18-year-old female patient experienced hives, swelling of the lip, hands, and feet, and fever after receiving an intramuscular deltoid injection of Menactra (lot number"U2339AA) number U2339AA) and Gardasil (lot number 0523U). The vaccines were administered on 12 June 2007, and within 24 hours the patient developed hives, swelling of the lip, hands, and feet, and fever (no documented temperature). Treatment included Benadryl and Tylenol Tylenol, and the patient was seen by her physician on 13 June 2007 and 18 June 2007. The patient had a history of scoliosis with spinal fusion (07 July 2005). No concomitant medications were reported, and it was unknown if the patient had any illness at the time of vaccination. Outcome was unknown.


Changed on 4/7/2010

284720 Before After
VAERS Form:
Age:18.0
Gender:Female
Location:Florida
Vaccinated:2007-06-12
Onset:2007-06-12
Submitted:2007-06-29
Entered:2007-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0523U / 0 UN / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2339AA / 0 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Lip swelling, Oedema peripheral, Pyrexia, Urticaria

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:
Current Illness:
Preexisting Conditions: Scoliosis, spinal fusion (08/Jul/2005)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 200702231

Write-up:A case was reported by a health professional in the United States on 18 June 2007. An 18-year-old female patient experienced hives, swelling of the lip, hands, and feet, and fever after receiving an intramuscular deltoid injection of Menactra (lot number U2339AA) and Gardasil (lot number 0523U). The vaccines were administered on 12 June 2007, and within 24 hours the patient developed hives, swelling of the lip, hands, and feet, and fever (no documented temperature). Treatment included Benadryl and Tylenol, and the patient was seen by her physician on 13 June 2007 and 18 June 2007. The patient had a history of scoliosis with spinal fusion (07 July 2005). No concomitant medications were reported, and it was unknown if the patient had any illness at the time of vaccination. Outcome was unknown.


Changed on 9/14/2017

284720 Before After
VAERS Form:(blank) 1
Age:18.0
Gender:Female
Location:Florida
Vaccinated:2007-06-12
Onset:2007-06-12
Submitted:2007-06-29
Entered:2007-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0523U / 0 1 UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2339AA / 0 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Lip swelling, Oedema peripheral, Pyrexia, Urticaria

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:
Current Illness:
Preexisting Conditions: Scoliosis, spinal fusion (08/Jul/2005)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': 200702231

Write-up:A case was reported by a health professional in the United States on 18 June 2007. An 18-year-old female patient experienced hives, swelling of the lip, hands, and feet, and fever after receiving an intramuscular deltoid injection of Menactra (lot number U2339AA) and Gardasil (lot number 0523U). The vaccines were administered on 12 June 2007, and within 24 hours the patient developed hives, swelling of the lip, hands, and feet, and fever (no documented temperature). Treatment included Benadryl and Tylenol, and the patient was seen by her physician on 13 June 2007 and 18 June 2007. The patient had a history of scoliosis with spinal fusion (07 July 2005). No concomitant medications were reported, and it was unknown if the patient had any illness at the time of vaccination. Outcome was unknown.


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