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This is VAERS ID 284775

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

284775
VAERS Form:
Age:18.0
Gender:Female
Location:Iowa
Vaccinated:2007-06-26
Onset:0000-00-00
Submitted:2007-07-16
Entered:2007-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1427F / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2181AA / 0 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B002AB / 0 LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Mydriasis, Pallor, Presyncope, Staring, Feeling of body temperature change

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: Pt had a near syncopal episode but with quickly placing supine was averted. Pt. observed x 30 min. and left feeling fine. Pt had not eaten. Given water and crackers.
CDC 'Split Type':

Write-up:HPV#1 was given and pt c/o a warm feeling, she started to stare, pupils dilated and color went pale. Pt was quickly helped to a supine position and was responsive and did not have a loss of consciousness due to quick action


Changed on 12/8/2009

284775 Before After
VAERS Form:
Age:18.0
Gender:Female
Location:Iowa
Vaccinated:2007-06-26
Onset:0000-00-00
Submitted:2007-07-16
Entered:2007-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1427F / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2181AA / 0 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B002AB / 0 LA / IM

Administered by: Public      Purchased by: Unknown Other
Symptoms: Mydriasis, Pallor, Presyncope, Staring, Feeling of body temperature change

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: Pt had a near syncopal episode but with quickly placing supine was averted. Pt. observed x 30 min. and left feeling fine. Pt had not eaten. Given water and crackers.
CDC 'Split Type':

Write-up:HPV#1 was given and pt c/o a warm feeling, she started to stare, pupils dilated and color went pale. Pt was quickly helped to a supine position and was responsive and did not have a loss of consciousness due to quick action


Changed on 4/7/2010

284775 Before After
VAERS Form:
Age:18.0
Gender:Female
Location:Iowa
Vaccinated:2007-06-26
Onset:0000-00-00
Submitted:2007-07-16
Entered:2007-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1427F / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2181AA / 0 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B002AB / 0 LA / IM

Administered by: Public      Purchased by: Other
Symptoms: Mydriasis, Pallor, Presyncope, Staring, Feeling of body temperature change

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: Pt had a near syncopal episode but with quickly placing supine was averted. Pt. observed x 30 min. and left feeling fine. Pt had not eaten. Given water and crackers.
CDC 'Split Type':

Write-up:HPV#1 was given and pt c/o a warm feeling, she started to stare, pupils dilated and color went pale. Pt was quickly helped to a supine position and was responsive and did not have a loss of consciousness due to quick action


Changed on 9/14/2017

284775 Before After
VAERS Form:(blank) 1
Age:18.0
Gender:Female
Location:Iowa
Vaccinated:2007-06-26
Onset:0000-00-00
Submitted:2007-07-16
Entered:2007-07-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1427F / 0 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2181AA / 0 1 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B002AB / 0 1 LA / IM

Administered by: Public      Purchased by: Other
Symptoms: Mydriasis, Pallor, Presyncope, Staring, Feeling of body temperature change

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: Pt had a near syncopal episode but with quickly placing supine was averted. Pt. observed x 30 min. and left feeling fine. Pt had not eaten. Given water and crackers.
CDC 'Split Type':

Write-up:HPV#1 was given and pt c/o a warm feeling, she started to stare, pupils dilated and color went pale. Pt was quickly helped to a supine position and was responsive and did not have a loss of consciousness due to quick action


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