|
VAERS ID: |
267426 (history) |
Form: |
Version 1.0 |
Age: |
15.0 |
Sex: |
Female |
Location: |
Unknown |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
2006-11-14 |
Entered: |
2006-11-16 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
- / 1 |
UN / IM |
Administered by: Other Purchased by: Other Symptoms: Rash erythematous,
Rash pruritic SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: NONE Current Illness: Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: NONE CDC Split Type: WAES0610USA06214
Write-up: Information has been received from a physician concerning her 15 year old daughter who was vaccinated with HPV. Subsequently, the patient experienced red dots/rashes on her ankles, elbows, and buttocks. Subsequently, the patient recovered from red dots/rashes on ankles, elbows, and buttocks. Therapy with HPV was not re-introduced. Additional information has been requested. 01/05/2007 Initial and follow up information has been received from a physician concerning her approximately 18 year old student daughter (previously reported as her 15 year old daughter) who was vaccinated with a first dose of GARDASIL. Subsequently, 48-72 hours after the first dose, the patient experienced red dots/rashes on her ankles, elbows, and buttocks, also reported as an itchy rash on ankles and abdomen. The patient was treated successfully with BENADRYL and recovered from red dots/rashes on ankles, elbows, and buttocks, also reported as an itchy rash on ankles and abdomen within 24 hours. Before the second dose of GARDASIL, the patient was pre-medicated with CLARITIN. No rash or other adverse experience was noted. Additional information is not expected. |
|
VAERS ID: |
267427 (history) |
Form: |
Version 1.0 |
Age: |
11.0 |
Sex: |
Female |
Location: |
Texas |
Vaccinated: | 2006-09-30 |
Onset: | 2006-10-01 |
Days after vaccination: | 1 |
Submitted: |
2006-11-14 |
Days after onset: | 44 |
Entered: |
2006-11-16 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. |
- / 2 |
UN / - |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0800F / UNK |
UN / UN |
Administered by: Other Purchased by: Other Symptoms: Facial palsy SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: UNK Current Illness: Preexisting Conditions: UNK Allergies: Diagnostic Lab Data: UNK CDC Split Type: WAES0610USA08291
Write-up: Information has been received from a physician concerning an 11 year old female who was the daughter of a nurse that works in his office. On 30-SEP-2006 the patient was vaccinated with a 0.5 ml dose of GARDASIL (lot #654540/0800F). At that same time, the patient received a second dose of FLUMIST. On 01-OCT-2006 the patient had a "funny feeling in her face." By 03-OCT-2006 "her face was crooked on one side and becoming paralyzed." The patient was treated with an unspecified steroid medication and was reported to be "feeling better," but the symptoms were not totally gone. The patient was seen by a neurologist and was diagnosed with Bell''s Palsy. The physician reported that one year ago, the patient was given FLUMIST and had no adverse reactions. At the time of this report, the patient was recovering from the events. The physician reported that it was his opinion that "Bells Palsy was caused by FLUMIST and not GARDASIL." Additional information has been requested. |
|
VAERS ID: |
267428 (history) |
Form: |
Version 1.0 |
Age: |
21.0 |
Sex: |
Female |
Location: |
Delaware |
Vaccinated: | 2006-09-21 |
Onset: | 2006-09-21 |
Days after vaccination: | 0 |
Submitted: |
2006-11-14 |
Days after onset: | 54 |
Entered: |
2006-11-16 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
- / UNK |
UN / UN |
Administered by: Other Purchased by: Other Symptoms: Urticaria SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: UNK Current Illness: Penicillin allergy; Sulfonamide allergy Preexisting Conditions: Hypersensitivity reaction Allergies: Diagnostic Lab Data: UNK CDC Split Type: WAES0610USA08303
Write-up: Information has been received from a nurse concerning a 21 year old female with a history of an allergic reaction to penicillin and sulfonamide who on 21-SEP-2006 was vaccinated with HPV. On 21-SEP-2006, following vaccination, the patient broke out in hives all over her upper body particularly in the face, chest, and arms. Unspecified medical attention was sought. Subsequently, the patient recovered on 26- SEP-2006. Additional information has been requested. |
|
VAERS ID: |
267429 (history) |
Form: |
Version 1.0 |
Age: |
22.0 |
Sex: |
Female |
Location: |
Florida |
Vaccinated: | 2006-10-05 |
Onset: | 2006-10-05 |
Days after vaccination: | 0 |
Submitted: |
2006-11-14 |
Days after onset: | 40 |
Entered: |
2006-11-16 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0955F / 1 |
- / - |
Administered by: Private Purchased by: Private Symptoms: Dizziness,
Fatigue,
Hypoaesthesia,
Injection site erythema,
Injection site hypersensitivity,
Injection site mass,
Malaise,
Pruritus,
Pyrexia,
Thermal burn SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: UNK Current Illness: Latex allergy; Drug hypersensitivity; Iodine allergy Preexisting Conditions: Vaccination adverse reaction Allergies: Diagnostic Lab Data: UNK CDC Split Type: WAES0610USA08337
Write-up: Information has been received from a physician and a 22 year old white female certified medical assistant with latex allergy, drug hypersensitivity to pertussis and iodine allergy and a history of unspecified adverse reaction after first dose of diphtheria toxoid (+) pertussis vaccine (unspecified) (+) tetanus toxoid (at less than 1 year of age. On 05-OCT-2006, at 4:00 PM,. the patient was vaccinated, into the right arm, with a first dose of HPV (lot # 653978/0955F). On 05-OCT-2006, at 4:00 PM, the patient experienced burning "as if the arm was cut with razor blade and alcohol was poured on cut," and it "hurt really bad." The patient also developed dizziness, numbness in her lower arm, fever, fatigue, and malaise. She reported that her arm swelled up 2 times the normal size and was red. She developed a dime size lump and redness at the injection site that was itchy when touched or pressed on. Unspecified medical attention was sought. At the time of the report, the dime size lump, redness and itching at the injection site persisted. No further information is available. |
|
VAERS ID: |
267430 (history) |
Form: |
Version 1.0 |
Age: |
16.0 |
Sex: |
Female |
Location: |
Florida |
Vaccinated: | 2006-10-05 |
Onset: | 2006-10-06 |
Days after vaccination: | 1 |
Submitted: |
2006-11-14 |
Days after onset: | 39 |
Entered: |
2006-11-16 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0688F / 1 |
- / - |
Administered by: Public Purchased by: Public Symptoms: Abdominal pain,
Dysuria,
Vaginal pain SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: NONE Current Illness: Preexisting Conditions: Unknown Allergies: Diagnostic Lab Data: Unknown CDC Split Type: WAES0610USA08344
Write-up: Information has been received from a certified medical assistant concerning a 16 year old female who on 05-OCT-2006 was vaccinated with a first dose of HPV (lot # 653735/0688F). There was no concomitant medication. on 06-OCT-2006 the patient experienced sharp pain around the abdomen area and vaginal area and intense pain during urination. It was reported that the pain was on and off. It was reported that the patient was going to go to the physician''s office to be evaluated. At the time of the report, the patient''s outcome was unknown. Additional information has been requested. 01/05/2007 Initial and follow-up information has been received from a certified medical assistant concerning a 16 year old female who on 05-OCT-2006 was vaccinated with a first dose of GARASIL (lot #653735/0688F). There was no concomitant medication. On 06-OCT-2006 the patient experienced sharp pain around the abdomen area and vaginal area and intense pain during urination. It was reported that the pain was on and off. It was reported that the patient was going to go to the physician''s office to be evaluated. At the time of the report, the patient''s outcome was unknown. Additional information is not available. |
|
VAERS ID: |
267431 (history) |
Form: |
Version 1.0 |
Age: |
12.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 2006-10-04 |
Onset: | 2006-10-04 |
Days after vaccination: | 0 |
Submitted: |
2006-11-14 |
Days after onset: | 41 |
Entered: |
2006-11-16 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
UN / UN |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
- / UNK |
UN / UN |
Administered by: Other Purchased by: Other Symptoms: Loss of consciousness,
Syncope vasovagal SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: NONE CDC Split Type: WAES0610USA08391
Write-up: Information has been received from a registered nurse concerning a 12 year old female with no past medical history who on approximately 10/4/06 was vaccinated, into the arm, with a 0.5ml dose of HPV vaccine. Concomitant therapy included a dose of Hep A vaccine. It was reported that the nurse rubbed the childs arm after the vaccination and the child passed out. The physician thought that it was a vasovagal reaction and revived her with ammonia. On approximately 10/04/06, the pt recovered. Additional information has been requested. |
|
VAERS ID: |
267432 (history) |
Form: |
Version 1.0 |
Age: |
13.0 |
Sex: |
Female |
Location: |
Pennsylvania |
Vaccinated: | 2006-10-11 |
Onset: | 2006-10-11 |
Days after vaccination: | 0 |
Submitted: |
2006-11-14 |
Days after onset: | 34 |
Entered: |
2006-11-16 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
UN / UN |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0800F / UNK |
UN / UN |
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. |
- / UNK |
UN / UN |
Administered by: Private Purchased by: Public Symptoms: Hypoaesthesia,
Injection site reaction SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Asthma, drug Hypersensitivity. Allergies: Diagnostic Lab Data: NONE CDC Split Type: WAES0610USA09277
Write-up: Information has been received from a physician concerning a 12 year old female with asthma and Advair allergy who on 10/11/06 was vaccinated with HVP vaccine. Concomitant therapy that day included varicella virus vaccine and influenza vaccine. On 10/11/06 the pt experienced numbing at injection site and around arm. The pt recovered. Unspecified medical attention was sought. Additional information has been requested. |
|
VAERS ID: |
267433 (history) |
Form: |
Version 1.0 |
Age: |
15.0 |
Sex: |
Female |
Location: |
Unknown |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: |
2006-11-14 |
Entered: |
2006-11-16 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
- / UNK |
UN / UN |
Administered by: Other Purchased by: Other Symptoms: Dizziness,
Flushing SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypersensitivity (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: (therapy unspecified) Current Illness: Preexisting Conditions: UNK Allergies: Diagnostic Lab Data: NONE CDC Split Type: WAES0610USA09299
Write-up: Information has been received from a nurse concerning her 15 year old niece who was vaccinated with HPV rL1 6 11 18 VLP vaccine (yeast) (0.5 ml). Subsequently, "soon after having injections", the patient experienced dizziness and flushing "about ten minutes after her injections". It was reported that the patient received HPV rL1 6 11 16 18 VLP vaccine (yeast) with "other shots" and blood work. The patient recovered ;about 15 minutes after injections". Unspecified medical attention was sought. Additional information has been requested. |
|
VAERS ID: |
267434 (history) |
Form: |
Version 1.0 |
Age: |
22.0 |
Sex: |
Female |
Location: |
Unknown |
Vaccinated: | 2006-08-30 |
Onset: | 0000-00-00 |
Submitted: |
2006-11-14 |
Entered: |
2006-11-16 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
- / UNK |
UN / UN |
Administered by: Other Purchased by: Other Symptoms: Abdominal pain upper,
Influenza like illness SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: UNK Current Illness: Preexisting Conditions: UNK Allergies: Diagnostic Lab Data: UNK CDC Split Type: WAES0610USA09300
Write-up: Information has been received from a 22 year old female nurse consumer who was vaccinated with a dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). Subsequently the patient experienced stomach ache and flu-like symptoms "for about a week''. The patient recovered. No further information is available. |
|
VAERS ID: |
267435 (history) |
Form: |
Version 1.0 |
Age: |
22.0 |
Sex: |
Female |
Location: |
Massachusetts |
Vaccinated: | 2006-10-11 |
Onset: | 2006-10-12 |
Days after vaccination: | 1 |
Submitted: |
2006-11-14 |
Days after onset: | 33 |
Entered: |
2006-11-16 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0955F / UNK |
- / IM |
Administered by: Other Purchased by: Other Symptoms: Rash SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: ORTHO TRI-CYCLEN Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: UNK CDC Split Type: WAES0610USA09303
Write-up: Information has been received from a physician concerning a 22 year old female who on 11-Oct-2006 was vaccinated with HPV rL1 6 11 16 18 VLP vaccine (yeast) (lot#653978/0955F) (0.5ml), intramuscularly. Concomitant therapy included ethinyl estradiol/norgestimate (ORTHO TRI-CYCLEN). On 12-Oct-2006 the patient experienced "rash on her face and neck". Unspecified medical attention was sought. At the time of this report, the outcome of the event was unknown. Additional information has been requested. |
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