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This is VAERS ID 309503

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 309503
VAERS Form:
Age:14.0
Gender:Female
Location:California
Vaccinated:2008-04-08
Onset:2008-04-08
Submitted:2008-04-14
Entered:2008-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
BCG: BCG (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1266U / 0 UN / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR - / - UN / UN

Administered by: Other      Purchased by: Unknown
Symptoms: Hypotension, Syncope

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Information has been received from a medical assistant concerning a 14 year old female who on 08-APR-2008 was vaccinated with GARDASIL (lot#659437/1266U) 0.5mL IM. Concomitant therapy included MENACTRA and /"TB/" vaccine (manufacturer unknown). On 08-APR-"28 the patient fainted after receiving GARDASIL. The medical assistant reported that the patient was rushed to the hospital via ambulance due to severe hypotension after receiving the vaccine. At the time of reporting it was unknown if the patient had rec


Changed on 12/8/2009

VAERS ID: 309503 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:California
Vaccinated:2008-04-08
Onset:2008-04-08
Submitted:2008-04-14
Entered:2008-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
BCG: BCG (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1266U / 0 UN / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR - / - UN / UN

Administered by: Other      Purchased by: Unknown Other
Symptoms: Hypotension, Syncope

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': (blank) WAES0804USA02247

Write-up: Information has been received from a medical assistant concerning a 14 year old female who on 08-APR-2008 was vaccinated with GARDASIL (lot#659437/1266U) 0.5mL IM. Concomitant therapy included MENACTRA and /"TB/" "TB" vaccine (manufacturer unknown). On 08-APR-"28 08-APR-28 the patient fainted after receiving GARDASIL. The medical assistant reported that the patient was rushed to the hospital via ambulance due to severe hypotension after receiving the vaccine. At the time of reporting it was unknown if the patient had rec recovered. The reporter felt that syncope and severe hypotension were considered to be disabling, life threatening and an other medical event. Additional information has been requested.


Changed on 4/7/2010

VAERS ID: 309503 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:California
Vaccinated:2008-04-08
Onset:2008-04-08
Submitted:2008-04-14
Entered:2008-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
BCG: BCG (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1266U / 0 UN / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Hypotension, Syncope

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0804USA02247

Write-up: Information has been received from a medical assistant concerning a 14 year old female who on 08-APR-2008 was vaccinated with GARDASIL (lot#659437/1266U) 0.5mL IM. Concomitant therapy included MENACTRA and "TB" vaccine (manufacturer unknown). On 08-APR-28 the patient fainted after receiving GARDASIL. The medical assistant reported that the patient was rushed to the hospital via ambulance due to severe hypotension after receiving the vaccine. At the time of reporting it was unknown if the patient had recovered. The reporter felt that syncope and severe hypotension were considered to be disabling, life threatening and an other medical event. Additional information has been requested.


Changed on 9/14/2017

VAERS ID: 309503 Before After
VAERS Form:(blank) 1
Age:14.0
Gender:Female
Location:California
Vaccinated:2008-04-08
Onset:2008-04-08
Submitted:2008-04-14
Entered:2008-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
BCG: BCG (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1266U / 0 1 UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / - UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Hypotension, Syncope

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0804USA02247

Write-up: Information has been received from a medical assistant concerning a 14 year old female who on 08-APR-2008 was vaccinated with GARDASIL (lot#659437/1266U) 0.5mL IM. Concomitant therapy included MENACTRA and "TB" vaccine (manufacturer unknown). On 08-APR-28 the patient fainted after receiving GARDASIL. The medical assistant reported that the patient was rushed to the hospital via ambulance due to severe hypotension after receiving the vaccine. At the time of reporting it was unknown if the patient had recovered. The reporter felt that syncope and severe hypotension were considered to be disabling, life threatening and an other medical event. Additional information has been requested.


Changed on 2/14/2018

VAERS ID: 309503 Before After
VAERS Form:1
Age:14.0
Gender:Female
Location:California
Vaccinated:2008-04-08
Onset:2008-04-08
Submitted:2008-04-14
Entered:2008-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
BCG: BCG (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1266U / 1 UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Hypotension, Syncope

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0804USA02247

Write-up: Information has been received from a medical assistant concerning a 14 year old female who on 08-APR-2008 was vaccinated with GARDASIL (lot#659437/1266U) 0.5mL IM. Concomitant therapy included MENACTRA and "TB" vaccine (manufacturer unknown). On 08-APR-28 the patient fainted after receiving GARDASIL. The medical assistant reported that the patient was rushed to the hospital via ambulance due to severe hypotension after receiving the vaccine. At the time of reporting it was unknown if the patient had recovered. The reporter felt that syncope and severe hypotension were considered to be disabling, life threatening and an other medical event. Additional information has been requested.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=309503&WAYBACKHISTORY=ON


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