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This is VAERS ID 263218

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

263218
VAERS Form:
Age:
Gender:Female
Location:California
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2006-09-14
Entered:2006-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. - / 0 - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Injection site reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up:Information has been received from a physician concerning a female (age not reported) who on an unspecified date was vaccinated intramuscularly with the first dose of 0.5 ml of HPV rLi 6 11 16 18 VLP vaccine (yeast). On an unspecified date, the patient d"eveloped /"burning at the injection site/". It was reported that the event improved after medical attention. It was reported that the event improved after /"stopping therapy/". At the time of this report, the outcome of the event was unknown. Addition


Changed on 12/8/2009

263218 Before After
VAERS Form:
Age:
Gender:Female
Location:California
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2006-09-14
Entered:2006-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. - / 0 - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Injection site reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': (blank) WAES0608USA04520

Write-up:Information has been received from a physician concerning a female (age not reported) who on an unspecified date was vaccinated intramuscularly with the first dose of 0.5 ml of HPV rLi 6 11 16 18 VLP vaccine (yeast). On an unspecified date, the patient d"eveloped /"burning developed "burning at the injection site/". site". It was reported that the event improved after medical attention. It was reported that the event improved after /"stopping therapy/". "stopping therapy". At the time of this report, the outcome of the event was unknown. Addition Additional information has been requested.


Changed on 1/5/2010

263218 Before After
VAERS Form:
Age:(blank) 52.0
Gender:Female
Location:California
Vaccinated:0000-00-00 2006-07-27
Onset:0000-00-00 2006-07-27
Submitted:2006-09-14 2007-01-06
Entered:2006-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 - / IM

Administered by: Other Private      Purchased by: Other
Symptoms: Injection site reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Yes
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: Unknown
Current Illness: Herpes labialis
Preexisting Conditions: Unknown Herpes virus infection
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0608USA04520

Write-up:Information This is in follow-up to report(s) previously submitted on 9/14/2006. Initial and follow-up information has been received from a physician concerning a 52 year old female (age not reported) who on an unspecified date with a history of a "herpes outbreak" two weeks ago. On 17-JUL-2006. "10 days prior" to receiving GARDASIL (yeast), the patient had taken acyclovir 200 mg. On 27-JUL-2006, the patient was vaccinated intramuscularly with the first dose of 0.5 ml mL of HPV rLi 6 11 16 18 VLP vaccine GARDASIL (yeast). On an unspecified date, the patient developed "burning at the injection site". It was reported that the event improved after medical attention. patient had "2 herpes lesions on her inner labia" at the time of vaccination. It was On 27-JUL-2006, the patient developed a neck ache, eyelashes fell out, "a decrease memory for people" and excessive dry eye. On 27-AUG-2006 the patient developed a migraine with vomiting (previously reported that the event improved after "stopping therapy". patient had "burning at the injection site"). The patient sought unspecified medical attention. At the time of this report, the outcome of patient had recovered from the event was unknown. events (date unknown). Additional information has been requested.


Changed on 9/14/2017

263218 Before After
VAERS Form:(blank) 1
Age:52.0
Gender:Female
Location:California
Vaccinated:2006-07-27
Onset:2006-07-27
Submitted:2007-01-06
Entered:2006-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 1 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Injection site reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Herpes labialis
Preexisting Conditions: Herpes virus infection
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0608USA04520

Write-up:This is in follow-up to report(s) previously submitted on 9/14/2006. Initial and follow-up information has been received from a physician concerning a 52 year old female with a history of a "herpes outbreak" two weeks ago. On 17-JUL-2006. "10 days prior" to receiving GARDASIL (yeast), the patient had taken acyclovir 200 mg. On 27-JUL-2006, the patient was vaccinated intramuscularly with the first dose of 0.5 mL of GARDASIL (yeast). It was reported that the patient had "2 herpes lesions on her inner labia" at the time of vaccination. On 27-JUL-2006, the patient developed a neck ache, eyelashes fell out, "a decrease memory for people" and excessive dry eye. On 27-AUG-2006 the patient developed a migraine with vomiting (previously reported that the patient had "burning at the injection site"). The patient sought unspecified medical attention. At the time of this report, the patient had recovered from the events (date unknown). Additional information has been requested.


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