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This is VAERS ID 288902

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 288902
VAERS Form:
Age:16.0
Sex:Female
Location:Arizona
Vaccinated:2007-08-03
Onset:2007-08-03
Submitted:2007-08-23
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. - / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0171U / - UN / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR - / - UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UN / UN

Administered by: Other      Purchased by: Unknown
Symptoms: Crying, Head injury, Loss of consciousness, Screaming, Skull fracture

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: 0     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: Clamminess; Cold; Anxiety Attack
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Information has been received from a physician and certified medical assistant concerning a 16 year old female, who on 03-AUG-2007 was vaccinated intramuscularly with a 0.5mL dose of Gardasil (Lot# 655620/0171U). Concomitant suspect vaccinations included"hepatitis A vaccine (inactive) (duration and dose not reported) and varicella virus vaccine live (duration and dose not reported). Other concomitant therapy included MENACTRA. On 03-AUG-2007 following the vaccinations, the patient fainted at the front des


Changed on 12/8/2009

VAERS ID: 288902 Before After
VAERS Form:
Age:16.0
Sex:Female
Location:Arizona
Vaccinated:2007-08-03
Onset:2007-08-03
Submitted:2007-08-23
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. - / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0171U / - UN / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR - / - UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UN / UN

Administered by: Other      Purchased by: Unknown Other
Symptoms: Crying, Head injury, Loss of consciousness, Screaming, Syncope, Skull fracture

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: 0     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: Clamminess; Cold; Anxiety Attack
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': (blank) WAES0708USA03128

Write-up: Information has been received from a physician and certified medical assistant concerning a 16 year old female, who on 03-AUG-2007 was vaccinated intramuscularly with a 0.5mL dose of Gardasil (Lot# 655620/0171U). Concomitant suspect vaccinations included"hepatitis included hepatitis A vaccine (inactive) (duration and dose not reported) and varicella virus vaccine live (duration and dose not reported). Other concomitant therapy included MENACTRA. On 03-AUG-2007 following the vaccinations, the patient fainted at the front des desk when she went to make the next appointment. The patient hit the back of her head and lost consciousness for 1 to 2 minutes. When the patient regained consciousness, the patient was screaming and crying. When the paramedics arrived and tried to get the patient into the ambulance, the patient was fighting with the paramedics. The patient was taken to the emergency room at a hospital then was transported to a pediatric hospital where she saw a pediatric neurologist. The patient was found to have a small fracture at the back of her head. The medical assistant mentioned to the nurse that the patient was cold, clammy, and had high anxiety prior to all the vaccines. The father mentioned that the patient has been having anxiety attacks. The office had offered to give 2 vaccinations at one visit and the other 2 at another time but the patient had refused. The patient recovered on an unspecified date. No product quality complaint was involved. Additional information is not expected.


Changed on 4/7/2010

VAERS ID: 288902 Before After
VAERS Form:
Age:16.0
Sex:Female
Location:Arizona
Vaccinated:2007-08-03
Onset:2007-08-03
Submitted:2007-08-23
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. - / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0171U / - UN / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / - UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Crying, Head injury, Loss of consciousness, Screaming, Syncope, Skull fracture

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: 0     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: Clamminess; Cold; Anxiety Attack
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0708USA03128

Write-up: Information has been received from a physician and certified medical assistant concerning a 16 year old female, who on 03-AUG-2007 was vaccinated intramuscularly with a 0.5mL dose of Gardasil (Lot# 655620/0171U). Concomitant suspect vaccinations included hepatitis A vaccine (inactive) (duration and dose not reported) and varicella virus vaccine live (duration and dose not reported). Other concomitant therapy included MENACTRA. On 03-AUG-2007 following the vaccinations, the patient fainted at the front desk when she went to make the next appointment. The patient hit the back of her head and lost consciousness for 1 to 2 minutes. When the patient regained consciousness, the patient was screaming and crying. When the paramedics arrived and tried to get the patient into the ambulance, the patient was fighting with the paramedics. The patient was taken to the emergency room at a hospital then was transported to a pediatric hospital where she saw a pediatric neurologist. The patient was found to have a small fracture at the back of her head. The medical assistant mentioned to the nurse that the patient was cold, clammy, and had high anxiety prior to all the vaccines. The father mentioned that the patient has been having anxiety attacks. The office had offered to give 2 vaccinations at one visit and the other 2 at another time but the patient had refused. The patient recovered on an unspecified date. No product quality complaint was involved. Additional information is not expected.


Changed on 9/14/2017

VAERS ID: 288902 Before After
VAERS Form:(blank) 1
Age:16.0
Sex:Female
Location:Arizona
Vaccinated:2007-08-03
Onset:2007-08-03
Submitted:2007-08-23
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. - / - UNK UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0171U / - UNK UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / - UNK UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / - UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Crying, Head injury, Loss of consciousness, Screaming, Syncope, Skull fracture

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: 0     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: Clamminess; Cold; Anxiety Attack
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0708USA03128

Write-up: Information has been received from a physician and certified medical assistant concerning a 16 year old female, who on 03-AUG-2007 was vaccinated intramuscularly with a 0.5mL dose of Gardasil (Lot# 655620/0171U). Concomitant suspect vaccinations included hepatitis A vaccine (inactive) (duration and dose not reported) and varicella virus vaccine live (duration and dose not reported). Other concomitant therapy included MENACTRA. On 03-AUG-2007 following the vaccinations, the patient fainted at the front desk when she went to make the next appointment. The patient hit the back of her head and lost consciousness for 1 to 2 minutes. When the patient regained consciousness, the patient was screaming and crying. When the paramedics arrived and tried to get the patient into the ambulance, the patient was fighting with the paramedics. The patient was taken to the emergency room at a hospital then was transported to a pediatric hospital where she saw a pediatric neurologist. The patient was found to have a small fracture at the back of her head. The medical assistant mentioned to the nurse that the patient was cold, clammy, and had high anxiety prior to all the vaccines. The father mentioned that the patient has been having anxiety attacks. The office had offered to give 2 vaccinations at one visit and the other 2 at another time but the patient had refused. The patient recovered on an unspecified date. No product quality complaint was involved. Additional information is not expected.


Changed on 2/14/2018

VAERS ID: 288902 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Arizona
Vaccinated:2007-08-03
Onset:2007-08-03
Submitted:2007-08-23
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. - / UNK UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0171U / UNK UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / UNK UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Crying, Head injury, Loss of consciousness, Screaming, Syncope, Skull fracture

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: 0     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: Clamminess; Cold; Anxiety Attack
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0708USA03128

Write-up: Information has been received from a physician and certified medical assistant concerning a 16 year old female, who on 03-AUG-2007 was vaccinated intramuscularly with a 0.5mL dose of Gardasil (Lot# 655620/0171U). Concomitant suspect vaccinations included hepatitis A vaccine (inactive) (duration and dose not reported) and varicella virus vaccine live (duration and dose not reported). Other concomitant therapy included MENACTRA. On 03-AUG-2007 following the vaccinations, the patient fainted at the front desk when she went to make the next appointment. The patient hit the back of her head and lost consciousness for 1 to 2 minutes. When the patient regained consciousness, the patient was screaming and crying. When the paramedics arrived and tried to get the patient into the ambulance, the patient was fighting with the paramedics. The patient was taken to the emergency room at a hospital then was transported to a pediatric hospital where she saw a pediatric neurologist. The patient was found to have a small fracture at the back of her head. The medical assistant mentioned to the nurse that the patient was cold, clammy, and had high anxiety prior to all the vaccines. The father mentioned that the patient has been having anxiety attacks. The office had offered to give 2 vaccinations at one visit and the other 2 at another time but the patient had refused. The patient recovered on an unspecified date. No product quality complaint was involved. Additional information is not expected.


Changed on 6/14/2018

VAERS ID: 288902 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Arizona
Vaccinated:2007-08-03
Onset:2007-08-03
Submitted:2007-08-23
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. - / UNK UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0171U / UNK UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / UNK UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Crying, Head injury, Loss of consciousness, Screaming, Syncope, Skull fracture

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: 0     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: Clamminess; Cold; Anxiety Attack
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0708USA03128

Write-up: Information has been received from a physician and certified medical assistant concerning a 16 year old female, who on 03-AUG-2007 was vaccinated intramuscularly with a 0.5mL dose of Gardasil (Lot# 655620/0171U). Concomitant suspect vaccinations included hepatitis A vaccine (inactive) (duration and dose not reported) and varicella virus vaccine live (duration and dose not reported). Other concomitant therapy included MENACTRA. On 03-AUG-2007 following the vaccinations, the patient fainted at the front desk when she went to make the next appointment. The patient hit the back of her head and lost consciousness for 1 to 2 minutes. When the patient regained consciousness, the patient was screaming and crying. When the paramedics arrived and tried to get the patient into the ambulance, the patient was fighting with the paramedics. The patient was taken to the emergency room at a hospital then was transported to a pediatric hospital where she saw a pediatric neurologist. The patient was found to have a small fracture at the back of her head. The medical assistant mentioned to the nurse that the patient was cold, clammy, and had high anxiety prior to all the vaccines. The father mentioned that the patient has been having anxiety attacks. The office had offered to give 2 vaccinations at one visit and the other 2 at another time but the patient had refused. The patient recovered on an unspecified date. No product quality complaint was involved. Additional information is not expected.


Changed on 8/14/2018

VAERS ID: 288902 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Arizona
Vaccinated:2007-08-03
Onset:2007-08-03
Submitted:2007-08-23
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. - / UNK UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0171U / UNK UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / UNK UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Crying, Head injury, Loss of consciousness, Screaming, Syncope, Skull fracture

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: 0     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: Clamminess; Cold; Anxiety Attack
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0708USA03128

Write-up: Information has been received from a physician and certified medical assistant concerning a 16 year old female, who on 03-AUG-2007 was vaccinated intramuscularly with a 0.5mL dose of Gardasil (Lot# 655620/0171U). Concomitant suspect vaccinations included hepatitis A vaccine (inactive) (duration and dose not reported) and varicella virus vaccine live (duration and dose not reported). Other concomitant therapy included MENACTRA. On 03-AUG-2007 following the vaccinations, the patient fainted at the front desk when she went to make the next appointment. The patient hit the back of her head and lost consciousness for 1 to 2 minutes. When the patient regained consciousness, the patient was screaming and crying. When the paramedics arrived and tried to get the patient into the ambulance, the patient was fighting with the paramedics. The patient was taken to the emergency room at a hospital then was transported to a pediatric hospital where she saw a pediatric neurologist. The patient was found to have a small fracture at the back of her head. The medical assistant mentioned to the nurse that the patient was cold, clammy, and had high anxiety prior to all the vaccines. The father mentioned that the patient has been having anxiety attacks. The office had offered to give 2 vaccinations at one visit and the other 2 at another time but the patient had refused. The patient recovered on an unspecified date. No product quality complaint was involved. Additional information is not expected.


Changed on 9/14/2018

VAERS ID: 288902 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Arizona
Vaccinated:2007-08-03
Onset:2007-08-03
Submitted:2007-08-23
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. - / UNK UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0171U / UNK UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / UNK UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Crying, Head injury, Loss of consciousness, Screaming, Syncope, Skull fracture

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: 0     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: Clamminess; Cold; Anxiety Attack
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0708USA03128

Write-up: Information has been received from a physician and certified medical assistant concerning a 16 year old female, who on 03-AUG-2007 was vaccinated intramuscularly with a 0.5mL dose of Gardasil (Lot# 655620/0171U). Concomitant suspect vaccinations included hepatitis A vaccine (inactive) (duration and dose not reported) and varicella virus vaccine live (duration and dose not reported). Other concomitant therapy included MENACTRA. On 03-AUG-2007 following the vaccinations, the patient fainted at the front desk when she went to make the next appointment. The patient hit the back of her head and lost consciousness for 1 to 2 minutes. When the patient regained consciousness, the patient was screaming and crying. When the paramedics arrived and tried to get the patient into the ambulance, the patient was fighting with the paramedics. The patient was taken to the emergency room at a hospital then was transported to a pediatric hospital where she saw a pediatric neurologist. The patient was found to have a small fracture at the back of her head. The medical assistant mentioned to the nurse that the patient was cold, clammy, and had high anxiety prior to all the vaccines. The father mentioned that the patient has been having anxiety attacks. The office had offered to give 2 vaccinations at one visit and the other 2 at another time but the patient had refused. The patient recovered on an unspecified date. No product quality complaint was involved. Additional information is not expected.


Changed on 10/14/2018

VAERS ID: 288902 Before After
VAERS Form:1
Age:16.0
Sex:Female
Location:Arizona
Vaccinated:2007-08-03
Onset:2007-08-03
Submitted:2007-08-23
Entered:2007-08-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. - / UNK UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0171U / UNK UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / UNK UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Crying, Head injury, Loss of consciousness, Screaming, Syncope, Skull fracture

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: 0     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: Clamminess; Cold; Anxiety Attack
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0708USA03128

Write-up: Information has been received from a physician and certified medical assistant concerning a 16 year old female, who on 03-AUG-2007 was vaccinated intramuscularly with a 0.5mL dose of Gardasil (Lot# 655620/0171U). Concomitant suspect vaccinations included hepatitis A vaccine (inactive) (duration and dose not reported) and varicella virus vaccine live (duration and dose not reported). Other concomitant therapy included MENACTRA. On 03-AUG-2007 following the vaccinations, the patient fainted at the front desk when she went to make the next appointment. The patient hit the back of her head and lost consciousness for 1 to 2 minutes. When the patient regained consciousness, the patient was screaming and crying. When the paramedics arrived and tried to get the patient into the ambulance, the patient was fighting with the paramedics. The patient was taken to the emergency room at a hospital then was transported to a pediatric hospital where she saw a pediatric neurologist. The patient was found to have a small fracture at the back of her head. The medical assistant mentioned to the nurse that the patient was cold, clammy, and had high anxiety prior to all the vaccines. The father mentioned that the patient has been having anxiety attacks. The office had offered to give 2 vaccinations at one visit and the other 2 at another time but the patient had refused. The patient recovered on an unspecified date. No product quality complaint was involved. Additional information is not expected.

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