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This is VAERS ID 302119

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

302119
VAERS Form:
Age:14.0
Gender:Female
Location:Texas
Vaccinated:2008-01-03
Onset:2008-01-03
Submitted:2008-01-09
Entered:2008-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Unknown
Symptoms: Dizziness, Loss of consciousness, Malaise, Nausea, Panic attack

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? No
Previous Vaccinations: n/a~ ()~NULL~~In Sibling1|n/a~ ()~NULL~~In Sibling2|none~ ()~NULL~~In Patient
Other Medications: Lexapro (10 mg. daily) and Buspar (30 mg. twice a day)
Current Illness: No illness present at time of vaccination.
Preexisting Conditions: Anxiety (takes the listed medications for this)
Allergies:
Diagnostic Lab Data: **Gardasil was also given but #13 on the form does not offer it as a choice. It was the first dose of the vaccine.
CDC 'Split Type': Anxiety (takes the listed medications for this)

Write-up:Amanda received a Tdap vaccine and a Gardasil vaccine on 1/3/08. She passed out from the vaccines. She has had no trouble with vaccines or shots in the past, including her last Tdap. She became very dizzy, and then passed out about 5-10 minutes after re"ceiving the vaccines. She also was nauseated and didn''''t feel well for several days. In addition, she takes medicines for panic disorder and the condition has been well controlled. After the vaccines, she experienced severe panic attacks for several days


Changed on 12/8/2009

302119 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Texas
Vaccinated:2008-01-03
Onset:2008-01-03
Submitted:2008-01-09
Entered:2008-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Dizziness, Loss of consciousness, Malaise, Nausea, Panic attack

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? No
Previous Vaccinations: n/a~ ()~NULL~~In Sibling1|n/a~ ()~NULL~~In Sibling2|none~ ()~NULL~~In Patient
Other Medications: Lexapro (10 mg. daily) and Buspar (30 mg. twice a day)
Current Illness: No illness present at time of vaccination.
Preexisting Conditions: Anxiety (takes the listed medications for this)
Allergies:
Diagnostic Lab Data: **Gardasil was also given but #13 on the form does not offer it as a choice. It was the first dose of the vaccine.
CDC 'Split Type': Anxiety (takes the listed medications for this) (blank)

Write-up:Amanda received a Tdap vaccine and a Gardasil vaccine on 1/3/08. She passed out from the vaccines. She has had no trouble with vaccines or shots in the past, including her last Tdap. She became very dizzy, and then passed out about 5-10 minutes after re"ceiving receiving the vaccines. She also was nauseated and didn''''t didn''t feel well for several days. In addition, she takes medicines for panic disorder and the condition has been well controlled. After the vaccines, she experienced severe panic attacks for several days and required an additional anxiety medicine. She had a follow-up visit with her pediatrician and her psychiatrist to evaluate her symptoms.


Changed on 4/11/2012

302119 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Texas
Vaccinated:2008-01-03
Onset:2008-01-03
Submitted:2008-01-09
Entered:2008-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 - / -
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Private Unknown      Purchased by: Private Unknown
Symptoms: Dizziness, Loss of consciousness, Malaise, Nausea, Panic attack

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? No
Previous Vaccinations: n/a~ ()~NULL~~In Sibling1|n/a~ ()~NULL~~In Sibling2|none~ ()~NULL~~In Patient none~ ()~~0.00~Patient|n/a~ ()~~0.00~Sibling|n/a~ ()~~0.00~Sibling
Other Medications: Lexapro (10 mg. daily) and Buspar (30 mg. twice a day)
Current Illness: No illness present at time of vaccination.
Preexisting Conditions: Anxiety (takes the listed medications for this)
Allergies:
Diagnostic Lab Data: **Gardasil was also given but #13 on the form does not offer it as a choice. It was the first dose of the vaccine.
CDC 'Split Type':

Write-up:Amanda Patient received a Tdap vaccine and a Gardasil vaccine on 1/3/08. She passed out from the vaccines. She has had no trouble with vaccines or shots in the past, including her last Tdap. She became very dizzy, and then passed out about 5-10 minutes after receiving the vaccines. She also was nauseated and didn''t feel well for several days. In addition, she takes medicines for panic disorder and the condition has been well controlled. After the vaccines, she experienced severe panic attacks for several days and required an additional anxiety medicine. She had a follow-up visit with her pediatrician and her psychiatrist to evaluate her symptoms.


Changed on 6/14/2014

302119 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Texas
Vaccinated:2008-01-03
Onset:2008-01-03
Submitted:2008-01-09
Entered:2008-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 - / -
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Dizziness, Loss of consciousness, Malaise, Nausea, Panic attack

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? No
Previous Vaccinations: none~ ()~~0.00~Patient|n/a~ ()~~0.00~Sibling|n/a~ ()~~0.00~Sibling
Other Medications: Lexapro (10 mg. daily) and Buspar (30 mg. twice a day)
Current Illness: No illness present at time of vaccination.
Preexisting Conditions: Anxiety (takes the listed medications for this)
Allergies:
Diagnostic Lab Data: **Gardasil was also given but #13 on the form does not offer it as a choice. It was the first dose of the vaccine.
CDC 'Split Type':

Write-up:Patient received a Tdap vaccine and a Gardasil vaccine on 1/3/08. She passed out from the vaccines. She has had no trouble with vaccines or shots in the past, including her last Tdap. She became very dizzy, and then passed out about 5-10 minutes after receiving the vaccines. She also was nauseated and didn''t feel well for several days. In addition, she takes medicines for panic disorder and the condition has been well controlled. After the vaccines, she experienced severe panic attacks for several days and required an additional anxiety medicine. She had a follow-up visit with her pediatrician and her psychiatrist to evaluate her symptoms.


Changed on 3/14/2015

302119 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Texas
Vaccinated:2008-01-03
Onset:2008-01-03
Submitted:2008-01-09
Entered:2008-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 - / -
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Dizziness, Loss of consciousness, Malaise, Nausea, Panic attack

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? No
Previous Vaccinations: n/a~ ()~~0.00~Sibling|none~ ()~~0.00~Patient|n/a~ ()~~0.00~Sibling
Other Medications: Lexapro (10 mg. daily) and Buspar (30 mg. twice a day)
Current Illness: No illness present at time of vaccination.
Preexisting Conditions: Anxiety (takes the listed medications for this)
Allergies:
Diagnostic Lab Data: **Gardasil was also given but #13 on the form does not offer it as a choice. It was the first dose of the vaccine.
CDC 'Split Type':

Write-up:Patient received a Tdap vaccine and a Gardasil vaccine on 1/3/08. She passed out from the vaccines. She has had no trouble with vaccines or shots in the past, including her last Tdap. She became very dizzy, and then passed out about 5-10 minutes after receiving the vaccines. She also was nauseated and didn''t feel well for several days. In addition, she takes medicines for panic disorder and the condition has been well controlled. After the vaccines, she experienced severe panic attacks for several days and required an additional anxiety medicine. She had a follow-up visit with her pediatrician and her psychiatrist to evaluate her symptoms.


Changed on 2/14/2017

302119 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Texas
Vaccinated:2008-01-03
Onset:2008-01-03
Submitted:2008-01-09
Entered:2008-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 - / -
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Dizziness, Loss of consciousness, Malaise, Nausea, Panic attack

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? No
Previous Vaccinations: n/a~ ()~~0.00~Sibling|none~ none~ ()~~0.00~Patient|n/a~ ()~~0.00~Sibling|n/a~ ()~~0.00~Sibling
Other Medications: Lexapro (10 mg. daily) and Buspar (30 mg. twice a day)
Current Illness: No illness present at time of vaccination.
Preexisting Conditions: Anxiety (takes the listed medications for this)
Allergies:
Diagnostic Lab Data: **Gardasil was also given but #13 on the form does not offer it as a choice. It was the first dose of the vaccine.
CDC 'Split Type':

Write-up:Patient received a Tdap vaccine and a Gardasil vaccine on 1/3/08. She passed out from the vaccines. She has had no trouble with vaccines or shots in the past, including her last Tdap. She became very dizzy, and then passed out about 5-10 minutes after receiving the vaccines. She also was nauseated and didn''t feel well for several days. In addition, she takes medicines for panic disorder and the condition has been well controlled. After the vaccines, she experienced severe panic attacks for several days and required an additional anxiety medicine. She had a follow-up visit with her pediatrician and her psychiatrist to evaluate her symptoms.


Changed on 9/14/2017

302119 Before After
VAERS Form:(blank) 1
Age:14.0
Gender:Female
Location:Texas
Vaccinated:2008-01-03
Onset:2008-01-03
Submitted:2008-01-09
Entered:2008-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 1 - / -
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK - / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Dizziness, Loss of consciousness, Malaise, Nausea, Panic attack

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? No
Previous Vaccinations: none~ ()~~0.00~Patient|n/a~ ()~~0.00~Sibling|n/a~ ()~~0.00~Sibling
Other Medications: Lexapro (10 mg. daily) and Buspar (30 mg. twice a day)
Current Illness: No illness present at time of vaccination.
Preexisting Conditions: Anxiety (takes the listed medications for this)
Allergies:
Diagnostic Lab Data: **Gardasil was also given but #13 on the form does not offer it as a choice. It was the first dose of the vaccine.
CDC 'Split Type':

Write-up:Patient received a Tdap vaccine and a Gardasil vaccine on 1/3/08. She passed out from the vaccines. She has had no trouble with vaccines or shots in the past, including her last Tdap. She became very dizzy, and then passed out about 5-10 minutes after receiving the vaccines. She also was nauseated and didn''t feel well for several days. In addition, she takes medicines for panic disorder and the condition has been well controlled. After the vaccines, she experienced severe panic attacks for several days and required an additional anxiety medicine. She had a follow-up visit with her pediatrician and her psychiatrist to evaluate her symptoms.


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