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This is VAERS ID 351067

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

351067
VAERS Form:
Age:13.0
Gender:Female
Location:New Jersey
Vaccinated:2007-06-14
Onset:2007-06-14
Submitted:2009-07-09
Entered:2009-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1210U / 1 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2688AA / - RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1503F / - RA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Aphonia, Asthenia, Chest discomfort, Chest X-ray normal, Cough, Crying, Dizziness, Dysgeusia, Dyspnoea, Fatigue, Headache, Hypersensitivity, Injection site pain, Laryngitis, Malaise, Respiratory tract congestion, Injection site swelling, Restless legs syndrome

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: None
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: LABS: CXR WNL.
CDC 'Split Type':

Write-up:Coughing, trouble breathing, loss of voice, malaise, crying, headache, chest discomfort, pain at injection site with swelling, dizziness, abdominal pain, weakness, fatigue, restless legs. 7/10/09 Received ER medical records of 5/10/2007. FINAL DX: laryngitis Records reveal patient had chest congestion, dry cough, abnormal taste x 1 week. Seen by PCP & dx w/allergies. OTC allergy med not helpful. Tx w/oral antibiotics & cough syrup. D/C to home w/PCP f/u. 11/23/09 Merdical recs received for date 5/7/07. OV for c/o sore throat. DX: postnasal drip. OV 5/14/07 c/o sore throat f/u ER visit. DX: postnasal drip.


Changed on 3/14/2015

351067 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:New Jersey
Vaccinated:2007-06-14
Onset:2007-06-14
Submitted:2009-07-09
Entered:2009-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1210U / 1 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2688AA / - RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1503F / - RA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Aphonia, Asthenia, Asthma, Chest discomfort, Chest X-ray normal, Cough, Crying, Dizziness, Dysgeusia, Dyspnoea, Fatigue, Headache, Hypersensitivity, Injection site pain, Laryngitis, Malaise, Respiratory tract congestion, Injection site swelling, Restless legs syndrome

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: None
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: LABS: CXR WNL.
CDC 'Split Type':

Write-up:Coughing, trouble breathing, loss of voice, malaise, crying, headache, chest discomfort, pain at injection site with swelling, dizziness, abdominal pain, weakness, fatigue, restless legs. 7/10/09 Received ER medical records of 5/10/2007. FINAL DX: laryngitis Records reveal patient had chest congestion, dry cough, abnormal taste x 1 week. Seen by PCP & dx w/allergies. OTC allergy med not helpful. Tx w/oral antibiotics & cough syrup. D/C to home w/PCP f/u. 11/23/09 Merdical recs received for date 5/7/07. OV for c/o sore throat. DX: postnasal drip. OV 5/14/07 c/o sore throat f/u ER visit. DX: postnasal drip.


Changed on 4/14/2017

351067 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:New Jersey
Vaccinated:2007-06-14
Onset:2007-06-14
Submitted:2009-07-09
Entered:2009-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1210U / 1 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2688AA / - RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1503F / - RA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Aphonia, Asthenia, Asthma, Chest discomfort, Chest X-ray normal, Cough, Crying, Dizziness, Dysgeusia, Dyspnoea, Fatigue, Headache, Hypersensitivity, Injection site pain, Laryngitis, Malaise, Respiratory tract congestion, Injection site swelling, Restless legs syndrome

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: None
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: LABS: CXR WNL.
CDC 'Split Type':

Write-up:Coughing, trouble breathing, loss of voice, malaise, crying, headache, chest discomfort, pain at injection site with swelling, dizziness, abdominal pain, weakness, fatigue, restless legs. 7/10/09 Received ER medical records of 5/10/2007. FINAL DX: laryngitis Records reveal patient had chest congestion, dry cough, abnormal taste x 1 week. Seen by PCP & dx w/allergies. OTC allergy med not helpful. Tx w/oral antibiotics & cough syrup. D/C to home w/PCP f/u. 11/23/09 Merdical recs received for date 5/7/07. OV for c/o sore throat. DX: postnasal drip. OV 5/14/07 c/o sore throat f/u ER visit. DX: postnasal drip.


Changed on 9/14/2017

351067 Before After
VAERS Form:(blank) 1
Age:13.0
Gender:Female
Location:New Jersey
Vaccinated:2007-06-14
Onset:2007-06-14
Submitted:2009-07-09
Entered:2009-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1210U / 1 2 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2688AA / - UNK RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1503F / - UNK RA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Aphonia, Asthenia, Chest discomfort, Cough, Crying, Dizziness, Dyspnoea, Fatigue, Headache, Injection site pain, Malaise, Injection site swelling, Restless legs syndrome

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: None
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: LABS: CXR WNL.
CDC 'Split Type':

Write-up:Coughing, trouble breathing, loss of voice, malaise, crying, headache, chest discomfort, pain at injection site with swelling, dizziness, abdominal pain, weakness, fatigue, restless legs. 7/10/09 Received ER medical records of 5/10/2007. FINAL DX: laryngitis Records reveal patient had chest congestion, dry cough, abnormal taste x 1 week. Seen by PCP & dx w/allergies. OTC allergy med not helpful. Tx w/oral antibiotics & cough syrup. D/C to home w/PCP f/u. 11/23/09 Merdical recs received for date 5/7/07. OV for c/o sore throat. DX: postnasal drip. OV 5/14/07 c/o sore throat f/u ER visit. DX: postnasal drip.


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