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This is VAERS ID 582197

History of Changes from the VAERS Wayback Machine

First Appeared on 7/14/2015

582197
VAERS Form:
Age:12.0
Gender:Female
Location:Oklahoma
Vaccinated:2012-09-19
Onset:2014-10-18
Submitted:2015-06-16
Entered:2015-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB642C / 1 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0555AE / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4289AA / 0 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B093B / 6 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H009738 / 1 LA / SC

Administered by: Private      Purchased by: Other
Symptoms: Computerised tomogram, Electroencephalogram, Generalised tonic-clonic seizure, Nuclear magnetic resonance imaging, Laboratory 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)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Mri eeg ct scans labs
CDC 'Split Type':

Write-up:Tonic clonic seizure.


Changed on 9/14/2017

582197 Before After
VAERS Form:(blank) 1
Age:12.0
Gender:Female
Location:Oklahoma
Vaccinated:2012-09-19
Onset:2014-10-18
Submitted:2015-06-16
Entered:2015-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB642C / 1 2 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0555AE / 0 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4289AA / 0 1 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B093B / 6 7+ LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. H009738 / 1 2 LA / SC

Administered by: Private      Purchased by: Other
Symptoms: Computerised tomogram, Electroencephalogram, Generalised tonic-clonic seizure, Nuclear magnetic resonance imaging, Laboratory 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)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Mri eeg ct scans labs
CDC 'Split Type':

Write-up:Tonic clonic seizure.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=582197&WAYBACKHISTORY=ON


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