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This is VAERS ID 284865

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

284865
VAERS Form:
Age:11.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-07-02
Onset:2007-07-02
Submitted:2007-07-06
Entered:2007-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0525U / 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0716U / 1 RA / SC

Administered by: Private      Purchased by: Unknown
Symptoms: Dizziness, Hyperhidrosis, Pallor

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:
Current Illness: None
Preexisting Conditions: Amoxicillin allergy
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up:Pt appeared very pale and diaphoretic /"feel like I''''m going to pass out/"-occurred 10 min after injection. VSS. Rested on side x 15 min and observed for total of 30 min.


Changed on 12/8/2009

284865 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-07-02
Onset:2007-07-02
Submitted:2007-07-06
Entered:2007-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0525U / 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0716U / 1 RA / SC

Administered by: Private      Purchased by: Unknown Private
Symptoms: Dizziness, Hyperhidrosis, Pallor

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:
Current Illness: None
Preexisting Conditions: Amoxicillin allergy
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up:Pt appeared very pale and diaphoretic /"feel "feel like I''''m I''m going to pass out/"-occurred out"-occurred 10 min after injection. VSS. Rested on side x 15 min and observed for total of 30 min.


Changed on 9/14/2017

284865 Before After
VAERS Form:(blank) 1
Age:11.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-07-02
Onset:2007-07-02
Submitted:2007-07-06
Entered:2007-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0525U / 1 2 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0716U / 1 2 RA / SC

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Hyperhidrosis, Pallor

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:
Current Illness: None
Preexisting Conditions: Amoxicillin allergy
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up:Pt appeared very pale and diaphoretic "feel like I''m going to pass out"-occurred 10 min after injection. VSS. Rested on side x 15 min and observed for total of 30 min.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=284865&WAYBACKHISTORY=ON


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