National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 612719

History of Changes from the VAERS Wayback Machine

First Appeared on 12/14/2015

612719
VAERS Form:
Age:16.0
Gender:Female
Location:Puerto Rico
Vaccinated:2013-08-19
Onset:2013-11-25
Submitted:2015-11-23
Entered:2015-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 5J5HT / 0 UN / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J006236 / 2 UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS M12092 / 0 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Brain stem glioma, Computerised tomogram, Death, Dizziness, Malaise, Nausea, Brain neoplasm

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-06-18
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: No
Preexisting Conditions: Asthma
Allergies:
Diagnostic Lab Data: She receive MENACTRA vaccine in 2/25/2009 and FLUZONE in 10/03/2013
CDC 'Split Type':

Write-up:In 10/2013 she said I don''t fell well, I have something in my head. She have CT scan, but in 11/25/2013 she awoke with nausea, dizzy she get another CT scan. But on January 13, 2014 I bring her E.R. in Hospital and they Dx with Pontine Glioma Tumor Brain.


Changed on 9/14/2017

612719 Before After
VAERS Form:(blank) 1
Age:16.0
Gender:Female
Location:Puerto Rico
Vaccinated:2013-08-19
Onset:2013-11-25
Submitted:2015-11-23
Entered:2015-12-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 5J5HT / 0 1 UN / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J006236 / 2 3 UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS M12092 / 0 1 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Brain stem glioma, Computerised tomogram, Death, Dizziness, Malaise, Nausea, Brain neoplasm

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2014-06-18
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: No
Preexisting Conditions: Asthma
Allergies:
Diagnostic Lab Data: She receive MENACTRA vaccine in 2/25/2009 and FLUZONE in 10/03/2013
CDC 'Split Type':

Write-up:In 10/2013 she said I don''t fell well, I have something in my head. She have CT scan, but in 11/25/2013 she awoke with nausea, dizzy she get another CT scan. But on January 13, 2014 I bring her E.R. in Hospital and they Dx with Pontine Glioma Tumor Brain.


New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=612719&WAYBACKHISTORY=ON


Copyright © 2017 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166