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This is VAERS ID 411211

History of Changes from the VAERS Wayback Machine

First Appeared on 12/7/2010

VAERS ID: 411211
VAERS Form:
Age:12.0
Gender:Female
Location:Massachusetts
Vaccinated:2010-12-02
Onset:2010-12-02
Submitted:2010-12-02
Entered:2010-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(10-11): INFLUENZA (SEASONAL) (FLUZONE 10-11) / SANOFI PASTEUR U3576AA / 0 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0766Z / 1 RA / IM

Administered by: Public      Purchased by: Other
Symptoms: Syncope

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:
Current Illness: NO
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: syncope


Changed on 7/12/2011

VAERS ID: 411211 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Massachusetts
Vaccinated:2010-12-02
Onset:2010-12-02
Submitted:2010-12-02
Entered:2010-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3576AA / 0 LA / IM
FLU(10-11): INFLUENZA (SEASONAL) (FLUZONE 10-11) / SANOFI PASTEUR U3576AA / 0 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0766Z / 1 RA / IM

Administered by: Public      Purchased by: Other
Symptoms: Syncope

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:
Current Illness: NO
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: syncope


Changed on 7/7/2013

VAERS ID: 411211 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Massachusetts
Vaccinated:2010-12-02
Onset:2010-12-02
Submitted:2010-12-02
Entered:2010-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3576AA / 0 LA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3576AA / 0 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0766Z / 1 RA / IM

Administered by: Public      Purchased by: Other
Symptoms: Syncope

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:
Current Illness: NO
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: syncope


Changed on 9/14/2017

VAERS ID: 411211 Before After
VAERS Form:(blank) 1
Age:12.0
Gender:Female
Location:Massachusetts
Vaccinated:2010-12-02
Onset:2010-12-02
Submitted:2010-12-02
Entered:2010-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3576AA / 0 1 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0766Z / 1 2 RA / IM

Administered by: Public      Purchased by: Other
Symptoms: Syncope

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:
Current Illness: NO
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: syncope


Changed on 2/14/2018

VAERS ID: 411211 Before After
VAERS Form:1
Age:12.0
Gender:Female
Location:Massachusetts
Vaccinated:2010-12-02
Onset:2010-12-02
Submitted:2010-12-02
Entered:2010-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3576AA / 1 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0766Z / 2 RA / IM

Administered by: Public      Purchased by: Other
Symptoms: Syncope

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:
Current Illness: NO
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: syncope


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