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This is VAERS ID 288215

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 288215
VAERS Form:
Age:16.0
Sex:Female
Location:Virginia
Vaccinated:2007-07-13
Onset:2007-07-13
Submitted:2007-08-10
Entered:2007-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1426F / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2277AA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C268AA / 0 RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Cardiac murmur, Computerised tomogram normal, Culture urine positive, Blood test normal, Drug screen negative

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Head CT scan normal, Blood test normal
CDC 'Split Type':

Write-up: Patient fell to floor and hit her head, developed LOC and tonic-clonic movements of arms for about 30 secs and recovered with full orientation for a few minutes then fell again and had a second similar episode. She was taken to the hospital ER when she ha"d a 3rd episode hours later. Recovered without any further problems.


Changed on 12/8/2009

VAERS ID: 288215 Before After
VAERS Form:
Age:16.0
Sex:Female
Location:Virginia
Vaccinated:2007-07-13
Onset:2007-07-13
Submitted:2007-08-10
Entered:2007-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1426F / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2277AA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C268AA / 0 RA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Cardiac murmur, Computerised tomogram normal, Culture urine positive, Fall, Full blood count normal, Head injury, Loss of consciousness, Syncope, Syncope vasovagal, Blood test normal, Drug screen negative, Tonic clonic movements, Urine analysis abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Head CT scan normal, Blood test normal normal. Labs and Diagnostics: Head CT with no focal mass effect. Drug screen (-). CBC WNL. UA with 6-10 WBCs and (+) leukocyte esterase. UC (+) for mixed skin flora.
CDC 'Split Type':

Write-up: Patient fell to floor and hit her head, developed LOC and tonic-clonic movements of arms for about 30 secs and recovered with full orientation for a few minutes then fell again and had a second similar episode. She was taken to the hospital ER when she ha"d had a 3rd episode hours later. Recovered without any further problems. 8/28/2007 MR received for ER visit following fainting episode with questionable seizure activity. When pt fell at health dept pt hit head, but pain has resolved. Pt passed out x1 in the ED BR. Clinical Impression Syncope, Vasovagal. Heart Murmurs NOS.


Changed on 4/7/2010

VAERS ID: 288215 Before After
VAERS Form:
Age:16.0
Sex:Female
Location:Virginia
Vaccinated:2007-07-13
Onset:2007-07-13
Submitted:2007-08-10
Entered:2007-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1426F / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2277AA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C268AA / 0 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac murmur, Computerised tomogram normal, Culture urine positive, Fall, Full blood count normal, Head injury, Loss of consciousness, Syncope, Syncope vasovagal, Blood test normal, Drug screen negative, Tonic clonic movements, Urine analysis abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Head CT scan normal, Blood test normal. Labs and Diagnostics: Head CT with no focal mass effect. Drug screen (-). CBC WNL. UA with 6-10 WBCs and (+) leukocyte esterase. UC (+) for mixed skin flora.
CDC 'Split Type':

Write-up: Patient fell to floor and hit her head, developed LOC and tonic-clonic movements of arms for about 30 secs and recovered with full orientation for a few minutes then fell again and had a second similar episode. She was taken to the hospital ER when she had a 3rd episode hours later. Recovered without any further problems. 8/28/2007 MR received for ER visit following fainting episode with questionable seizure activity. When pt fell at health dept pt hit head, but pain has resolved. Pt passed out x1 in the ED BR. Clinical Impression Syncope, Vasovagal. Heart Murmurs NOS.


Changed on 5/14/2017

VAERS ID: 288215 Before After
VAERS Form:
Age:16.0
Sex:Female
Location:Virginia
Vaccinated:2007-07-13
Onset:2007-07-13
Submitted:2007-08-10
Entered:2007-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1426F / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2277AA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C268AA / 0 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Cardiac murmur, Computerised tomogram normal, Culture urine positive, Fall, Full blood count normal, Head injury, Loss of consciousness, Syncope, Syncope vasovagal, Blood test normal, Drug screen negative, Tonic clonic movements, Urine analysis abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Head CT scan normal, Blood test normal. Labs and Diagnostics: Head CT with no focal mass effect. Drug screen (-). CBC WNL. UA with 6-10 WBCs and (+) leukocyte esterase. UC (+) for mixed skin flora.
CDC 'Split Type':

Write-up: Patient fell to floor and hit her head, developed LOC and tonic-clonic movements of arms for about 30 secs and recovered with full orientation for a few minutes then fell again and had a second similar episode. She was taken to the hospital ER when she had a 3rd episode hours later. Recovered without any further problems. 8/28/2007 MR received for ER visit following fainting episode with questionable seizure activity. When pt fell at health dept pt hit head, but pain has resolved. Pt passed out x1 in the ED BR. Clinical Impression Syncope, Vasovagal. Heart Murmurs NOS.


Changed on 9/14/2017

VAERS ID: 288215 Before After
VAERS Form:(blank) 1
Age:16.0
Sex:Female
Location:Virginia
Vaccinated:2007-07-13
Onset:2007-07-13
Submitted:2007-08-10
Entered:2007-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1426F / 0 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2277AA / 0 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C268AA / 0 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Computerised tomogram normal, Fall, Head injury, Loss of consciousness, Blood test normal, Tonic clonic movements

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Head CT scan normal, Blood test normal. Labs and Diagnostics: Head CT with no focal mass effect. Drug screen (-). CBC WNL. UA with 6-10 WBCs and (+) leukocyte esterase. UC (+) for mixed skin flora.
CDC 'Split Type':

Write-up: Patient fell to floor and hit her head, developed LOC and tonic-clonic movements of arms for about 30 secs and recovered with full orientation for a few minutes then fell again and had a second similar episode. She was taken to the hospital ER when she had a 3rd episode hours later. Recovered without any further problems. 8/28/2007 MR received for ER visit following fainting episode with questionable seizure activity. When pt fell at health dept pt hit head, but pain has resolved. Pt passed out x1 in the ED BR. Clinical Impression Syncope, Vasovagal. Heart Murmurs NOS.


Changed on 2/14/2018

VAERS ID: 288215 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Virginia
Vaccinated:2007-07-13
Onset:2007-07-13
Submitted:2007-08-10
Entered:2007-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1426F / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2277AA / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C268AA / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Computerised tomogram normal, Fall, Head injury, Loss of consciousness, Blood test normal, Tonic clonic movements

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Head CT scan normal, Blood test normal. Labs and Diagnostics: Head CT with no focal mass effect. Drug screen (-). CBC WNL. UA with 6-10 WBCs and (+) leukocyte esterase. UC (+) for mixed skin flora.
CDC 'Split Type':

Write-up: Patient fell to floor and hit her head, developed LOC and tonic-clonic movements of arms for about 30 secs and recovered with full orientation for a few minutes then fell again and had a second similar episode. She was taken to the hospital ER when she had a 3rd episode hours later. Recovered without any further problems. 8/28/2007 MR received for ER visit following fainting episode with questionable seizure activity. When pt fell at health dept pt hit head, but pain has resolved. Pt passed out x1 in the ED BR. Clinical Impression Syncope, Vasovagal. Heart Murmurs NOS.


Changed on 6/14/2018

VAERS ID: 288215 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Virginia
Vaccinated:2007-07-13
Onset:2007-07-13
Submitted:2007-08-10
Entered:2007-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1426F / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2277AA / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C268AA / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Computerised tomogram normal, Fall, Head injury, Loss of consciousness, Blood test normal, Tonic clonic movements

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Head CT scan normal, Blood test normal. Labs and Diagnostics: Head CT with no focal mass effect. Drug screen (-). CBC WNL. UA with 6-10 WBCs and (+) leukocyte esterase. UC (+) for mixed skin flora.
CDC 'Split Type':

Write-up: Patient fell to floor and hit her head, developed LOC and tonic-clonic movements of arms for about 30 secs and recovered with full orientation for a few minutes then fell again and had a second similar episode. She was taken to the hospital ER when she had a 3rd episode hours later. Recovered without any further problems. 8/28/2007 MR received for ER visit following fainting episode with questionable seizure activity. When pt fell at health dept pt hit head, but pain has resolved. Pt passed out x1 in the ED BR. Clinical Impression Syncope, Vasovagal. Heart Murmurs NOS.


Changed on 8/14/2018

VAERS ID: 288215 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Virginia
Vaccinated:2007-07-13
Onset:2007-07-13
Submitted:2007-08-10
Entered:2007-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1426F / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2277AA / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C268AA / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Computerised tomogram normal, Fall, Head injury, Loss of consciousness, Blood test normal, Tonic clonic movements

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Head CT scan normal, Blood test normal. Labs and Diagnostics: Head CT with no focal mass effect. Drug screen (-). CBC WNL. UA with 6-10 WBCs and (+) leukocyte esterase. UC (+) for mixed skin flora.
CDC 'Split Type':

Write-up: Patient fell to floor and hit her head, developed LOC and tonic-clonic movements of arms for about 30 secs and recovered with full orientation for a few minutes then fell again and had a second similar episode. She was taken to the hospital ER when she had a 3rd episode hours later. Recovered without any further problems. 8/28/2007 MR received for ER visit following fainting episode with questionable seizure activity. When pt fell at health dept pt hit head, but pain has resolved. Pt passed out x1 in the ED BR. Clinical Impression Syncope, Vasovagal. Heart Murmurs NOS.


Changed on 9/14/2018

VAERS ID: 288215 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Virginia
Vaccinated:2007-07-13
Onset:2007-07-13
Submitted:2007-08-10
Entered:2007-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1426F / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2277AA / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C268AA / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Computerised tomogram normal, Fall, Head injury, Loss of consciousness, Blood test normal, Tonic clonic movements

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Head CT scan normal, Blood test normal. Labs and Diagnostics: Head CT with no focal mass effect. Drug screen (-). CBC WNL. UA with 6-10 WBCs and (+) leukocyte esterase. UC (+) for mixed skin flora.
CDC 'Split Type':

Write-up: Patient fell to floor and hit her head, developed LOC and tonic-clonic movements of arms for about 30 secs and recovered with full orientation for a few minutes then fell again and had a second similar episode. She was taken to the hospital ER when she had a 3rd episode hours later. Recovered without any further problems. 8/28/2007 MR received for ER visit following fainting episode with questionable seizure activity. When pt fell at health dept pt hit head, but pain has resolved. Pt passed out x1 in the ED BR. Clinical Impression Syncope, Vasovagal. Heart Murmurs NOS.


Changed on 10/14/2018

VAERS ID: 288215 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Virginia
Vaccinated:2007-07-13
Onset:2007-07-13
Submitted:2007-08-10
Entered:2007-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1426F / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2277AA / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C268AA / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Computerised tomogram normal, Fall, Head injury, Loss of consciousness, Blood test normal, Tonic clonic movements

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Head CT scan normal, Blood test normal. Labs and Diagnostics: Head CT with no focal mass effect. Drug screen (-). CBC WNL. UA with 6-10 WBCs and (+) leukocyte esterase. UC (+) for mixed skin flora.
CDC 'Split Type':

Write-up: Patient fell to floor and hit her head, developed LOC and tonic-clonic movements of arms for about 30 secs and recovered with full orientation for a few minutes then fell again and had a second similar episode. She was taken to the hospital ER when she had a 3rd episode hours later. Recovered without any further problems. 8/28/2007 MR received for ER visit following fainting episode with questionable seizure activity. When pt fell at health dept pt hit head, but pain has resolved. Pt passed out x1 in the ED BR. Clinical Impression Syncope, Vasovagal. Heart Murmurs NOS.

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