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This is VAERS ID 395997

History of Changes from the VAERS Wayback Machine

First Appeared on 8/31/2010

395997
VAERS Form:
Age:13.0
Gender:Male
Location:Louisiana
Vaccinated:2010-08-06
Onset:2010-08-06
Submitted:2010-08-19
Entered:2010-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1332Y / 0 RA / IM
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR U3057AA / - RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U3051AA / 5 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Anxiety, Convulsion, Electrocardiogram, Fall, Hypotension, Tachycardia, Postictal state, Blood test

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
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:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1008USA00979

Write-up:Information has been received from a consumer concerning her 13 year old son with no known drug reactions or allergies or pertinent medical history who on 06-AUG-2010, was intramuscularly vaccinated in the left arm with the first dose of GARDASIL, in the physician office. There was no concomitant medication. On 06-AUG-2010, following the administration of GARDASIL, the patient walked to the waiting room to sit with his mother. Within two or three minutes the patient fell to the ground seizing. The seizure activity lasted approximately three minutes. Emergency medical service was called because of sustained tachycardia and low blood pressure. It was noted that this resolved with a lengthening of the postictal phase of the seizure. The patient was then transported to the emergency room by his mother where blood work and electrocardiogram were performed (results not provided). The patient was then discharged to his home. According to the patient''s mother he was currently very anxious. "Patient fell to the ground seizing", sustained tachycardia, low blood pressure and very anxious were considered to be disabling and life-threatening by the reporter. Additional information has been requested.


Changed on 12/7/2010

395997 Before After
VAERS Form:
Age:13.0
Gender:Male
Location:Louisiana
Vaccinated:2010-08-06
Onset:2010-08-06
Submitted:2010-08-19
Entered:2010-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1332Y / 0 RA / IM
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR U3057AA / - RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3057AA / - RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U3051AA / 5 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Anxiety, Convulsion, Electrocardiogram, Fall, Hypotension, Tachycardia, Postictal state, Blood test

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
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:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1008USA00979

Write-up:Information has been received from a consumer concerning her 13 year old son with no known drug reactions or allergies or pertinent medical history who on 06-AUG-2010, was intramuscularly vaccinated in the left arm with the first dose of GARDASIL, in the physician office. There was no concomitant medication. On 06-AUG-2010, following the administration of GARDASIL, the patient walked to the waiting room to sit with his mother. Within two or three minutes the patient fell to the ground seizing. The seizure activity lasted approximately three minutes. Emergency medical service was called because of sustained tachycardia and low blood pressure. It was noted that this resolved with a lengthening of the postictal phase of the seizure. The patient was then transported to the emergency room by his mother where blood work and electrocardiogram were performed (results not provided). The patient was then discharged to his home. According to the patient''s mother he was currently very anxious. "Patient fell to the ground seizing", sustained tachycardia, low blood pressure and very anxious were considered to be disabling and life-threatening by the reporter. Additional information has been requested.


Changed on 1/4/2011

395997 Before After
VAERS Form:
Age:13.0
Gender:Male
Location:Louisiana
Vaccinated:2010-08-06
Onset:2010-08-06
Submitted:2010-08-19
Entered:2010-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1332Y / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3057AA / - RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U3051AA / 5 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Anxiety, Convulsion, Electrocardiogram, Fall, Hypotension, Tachycardia, Postictal state, Blood test

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
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:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1008USA00979

Write-up:Information has been received from a consumer concerning her 13 year old son with no known drug reactions or allergies or pertinent medical history who on 06-AUG-2010, was intramuscularly vaccinated in the left arm with the first dose of GARDASIL, in the physician office. There was no concomitant medication. On 06-AUG-2010, following the administration of GARDASIL, the patient walked to the waiting room to sit with his mother. Within two or three minutes the patient fell to the ground seizing. The seizure activity lasted approximately three minutes. Emergency medical service was called because of sustained tachycardia and low blood pressure. It was noted that this resolved with a lengthening of the postictal phase of the seizure. The patient was then transported to the emergency room by his mother where blood work and electrocardiogram were performed (results not provided). The patient was then discharged to his home. According to the patient''s mother he was currently very anxious. "Patient fell to the ground seizing", sustained tachycardia, low blood pressure and very anxious were considered to be disabling and life-threatening by the reporter. Additional information has been requested.


Changed on 4/13/2011

395997 Before After
VAERS Form:
Age:13.0
Gender:Male
Location:Louisiana
Vaccinated:2010-08-06
Onset:2010-08-06
Submitted:2010-08-19
Entered:2010-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1332Y / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3057AA / - RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U3051AA / 5 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Anxiety, Blood pressure decreased, Bradycardia, Convulsion, Dehydration, Electrocardiogram, Fall, Hypotension, Injection site anaesthesia, Muscle twitching, Nausea, Syncope, Tachycardia, Postictal state, Injection site discomfort, Gaze palsy, Blood test

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
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:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1008USA00979

Write-up:Information has been received from a consumer concerning her 13 year old son with no known drug reactions or allergies or pertinent medical history who on 06-AUG-2010, was intramuscularly vaccinated in the left arm with the first dose of GARDASIL, in the physician office. There was no concomitant medication. On 06-AUG-2010, following the administration of GARDASIL, the patient walked to the waiting room to sit with his mother. Within two or three minutes the patient fell to the ground seizing. The seizure activity lasted approximately three minutes. Emergency medical service was called because of sustained tachycardia and low blood pressure. It was noted that this resolved with a lengthening of the postictal phase of the seizure. The patient was then transported to the emergency room by his mother where blood work and electrocardiogram were performed (results not provided). The patient was then discharged to his home. According to the patient''s mother he was currently very anxious. "Patient fell to the ground seizing", sustained tachycardia, low blood pressure and very anxious were considered to be disabling and life-threatening by the reporter. Additional information has been requested.


Changed on 5/13/2011

395997 Before After
VAERS Form:
Age:13.0
Gender:Male
Location:Louisiana
Vaccinated:2010-08-06
Onset:2010-08-06
Submitted:2010-08-19
Entered:2010-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1332Y / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3057AA / - RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U3051AA / 5 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Anxiety, Blood pressure decreased, Bradycardia, Convulsion, Dehydration, Electrocardiogram, Fall, Hypotension, Injection site anaesthesia, Muscle twitching, Nausea, Syncope, Tachycardia, Postictal state, Injection site discomfort, Gaze palsy, Blood test

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
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:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1008USA00979

Write-up:Information has been received from a consumer concerning her 13 year old son with no known drug reactions or allergies or pertinent medical history who on 06-AUG-2010, was intramuscularly vaccinated in the left arm with the first dose of GARDASIL, in the physician office. There was no concomitant medication. On 06-AUG-2010, following the administration of GARDASIL, the patient walked to the waiting room to sit with his mother. Within two or three minutes the patient fell to the ground seizing. The seizure activity lasted approximately three minutes. Emergency medical service was called because of sustained tachycardia and low blood pressure. It was noted that this resolved with a lengthening of the postictal phase of the seizure. The patient was then transported to the emergency room by his mother where blood work and electrocardiogram were performed (results not provided). The patient was then discharged to his home. According to the patient''s mother he was currently very anxious. "Patient fell to the ground seizing", sustained tachycardia, low blood pressure and very anxious were considered to be disabling and life-threatening by the reporter. Additional information has been requested.


Changed on 6/14/2014

395997 Before After
VAERS Form:
Age:13.0
Gender:Male
Location:Louisiana
Vaccinated:2010-08-06
Onset:2010-08-06
Submitted:2010-08-19
Entered:2010-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1332Y / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3057AA / - RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U3051AA / 5 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Anxiety, Convulsion, Electrocardiogram, Fall, Hypotension, Tachycardia, Postictal state, Blood test

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
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:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1008USA00979

Write-up:Information has been received from a consumer concerning her 13 year old son with no known drug reactions or allergies or pertinent medical history who on 06-AUG-2010, was intramuscularly vaccinated in the left arm with the first dose of GARDASIL, in the physician office. There was no concomitant medication. On 06-AUG-2010, following the administration of GARDASIL, the patient walked to the waiting room to sit with his mother. Within two or three minutes the patient fell to the ground seizing. The seizure activity lasted approximately three minutes. Emergency medical service was called because of sustained tachycardia and low blood pressure. It was noted that this resolved with a lengthening of the postictal phase of the seizure. The patient was then transported to the emergency room by his mother where blood work and electrocardiogram were performed (results not provided). The patient was then discharged to his home. According to the patient''s mother he was currently very anxious. "Patient fell to the ground seizing", sustained tachycardia, low blood pressure and very anxious were considered to be disabling and life-threatening by the reporter. Additional information has been requested.


Changed on 4/14/2017

395997 Before After
VAERS Form:
Age:13.0
Gender:Male
Location:Louisiana
Vaccinated:2010-08-06
Onset:2010-08-06
Submitted:2010-08-19
Entered:2010-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1332Y / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3057AA / - RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U3051AA / 5 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Anxiety, Convulsion, Electrocardiogram, Fall, Hypotension, Tachycardia, Postictal state, Blood test

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
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:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1008USA00979

Write-up:Information has been received from a consumer concerning her 13 year old son with no known drug reactions or allergies or pertinent medical history who on 06-AUG-2010, was intramuscularly vaccinated in the left arm with the first dose of GARDASIL, in the physician office. There was no concomitant medication. On 06-AUG-2010, following the administration of GARDASIL, the patient walked to the waiting room to sit with his mother. Within two or three minutes the patient fell to the ground seizing. The seizure activity lasted approximately three minutes. Emergency medical service was called because of sustained tachycardia and low blood pressure. It was noted that this resolved with a lengthening of the postictal phase of the seizure. The patient was then transported to the emergency room by his mother where blood work and electrocardiogram were performed (results not provided). The patient was then discharged to his home. According to the patient''s mother he was currently very anxious. "Patient fell to the ground seizing", sustained tachycardia, low blood pressure and very anxious were considered to be disabling and life-threatening by the reporter. Additional information has been requested.


Changed on 9/14/2017

395997 Before After
VAERS Form:(blank) 1
Age:13.0
Gender:Male
Location:Louisiana
Vaccinated:2010-08-06
Onset:2010-08-06
Submitted:2010-08-19
Entered:2010-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1332Y / 0 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3057AA / - UNK RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U3051AA / 5 6 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Anxiety, Convulsion, Electrocardiogram, Fall, Hypotension, Tachycardia, Postictal state, Blood test

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
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:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1008USA00979

Write-up:Information has been received from a consumer concerning her 13 year old son with no known drug reactions or allergies or pertinent medical history who on 06-AUG-2010, was intramuscularly vaccinated in the left arm with the first dose of GARDASIL, in the physician office. There was no concomitant medication. On 06-AUG-2010, following the administration of GARDASIL, the patient walked to the waiting room to sit with his mother. Within two or three minutes the patient fell to the ground seizing. The seizure activity lasted approximately three minutes. Emergency medical service was called because of sustained tachycardia and low blood pressure. It was noted that this resolved with a lengthening of the postictal phase of the seizure. The patient was then transported to the emergency room by his mother where blood work and electrocardiogram were performed (results not provided). The patient was then discharged to his home. According to the patient''s mother he was currently very anxious. "Patient fell to the ground seizing", sustained tachycardia, low blood pressure and very anxious were considered to be disabling and life-threatening by the reporter. Additional information has been requested.


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