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This is VAERS ID 290709

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 290709
VAERS Form:
Age:12.0
Gender:Female
Location:South Carolina
Vaccinated:2007-09-06
Onset:0000-00-00
Submitted:2007-09-10
Entered:2007-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2408AA / 0 RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Wrong drug administered

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: N/A
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Gardasil 0.5 ml lot # 0930U, Exp 11/10 given IM inadvertently instead of Tdap.


Changed on 12/8/2009

VAERS ID: 290709 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:South Carolina
Vaccinated:2007-09-06
Onset:0000-00-00
Submitted:2007-09-10
Entered:2007-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2408AA / 0 RA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Wrong drug administered

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: N/A
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Gardasil 0.5 ml lot # 0930U, Exp 11/10 given IM inadvertently instead of Tdap.


Changed on 4/7/2010

VAERS ID: 290709 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:South Carolina
Vaccinated:2007-09-06
Onset:0000-00-00
Submitted:2007-09-10
Entered:2007-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2408AA / 0 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Wrong drug administered

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: N/A
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Gardasil 0.5 ml lot # 0930U, Exp 11/10 given IM inadvertently instead of Tdap.


Changed on 9/14/2017

VAERS ID: 290709 Before After
VAERS Form:(blank) 1
Age:12.0
Gender:Female
Location:South Carolina
Vaccinated:2007-09-06
Onset:0000-00-00
Submitted:2007-09-10
Entered:2007-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2408AA / 0 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Wrong drug administered

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: N/A
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Gardasil 0.5 ml lot # 0930U, Exp 11/10 given IM inadvertently instead of Tdap.


Changed on 2/14/2018

VAERS ID: 290709 Before After
VAERS Form:1
Age:12.0
Gender:Female
Location:South Carolina
Vaccinated:2007-09-06
Onset:0000-00-00
Submitted:2007-09-10
Entered:2007-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2408AA / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Wrong drug administered

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: N/A
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Gardasil 0.5 ml lot # 0930U, Exp 11/10 given IM inadvertently instead of Tdap.


Changed on 6/14/2018

VAERS ID: 290709 Before After
VAERS Form:1
Age:12.0
Gender:Female
Location:South Carolina
Vaccinated:2007-09-06
Onset:0000-00-00
Submitted:2007-09-10
Entered:2007-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2408AA / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Wrong drug administered

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: N/A
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Gardasil 0.5 ml lot # 0930U, Exp 11/10 given IM inadvertently instead of Tdap.

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