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This is VAERS ID 263229

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

263229
VAERS Form:
Age:17.0
Gender:Female
Location:Texas
Vaccinated:2006-07-19
Onset:2006-07-19
Submitted:2006-09-14
Entered:2006-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0637F / 0 UN / -

Administered by: Other      Purchased by: Unknown
Symptoms: Erythema, Pain

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: Unknown
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up:Information has been received from a registered nurse concerning a 17 year old female with no medical history who on 19-JUL-2006 was vaccinated in the right deltoid with the first dose of HPV rLi 6 11 16 18 VLP vaccine (yeast) (lot#653937/0637F). Subsequ"ently on approximately site that lasted approximately 60 to 90 seconds and her arm became red and painful enough to cause the patient to cry. The patient subsequently recovered from the pain in the extremity, erythema, and injection site irritation. Add


Changed on 12/8/2009

263229 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Texas
Vaccinated:2006-07-19
Onset:2006-07-19
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. 0637F / 0 UN / -

Administered by: Other      Purchased by: Unknown Other
Symptoms: Erythema, Pain

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: Unknown
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': (blank) WAES0608USA06310

Write-up:Information has been received from a registered nurse concerning a 17 year old female with no medical history who on 19-JUL-2006 was vaccinated in the right deltoid with the first dose of HPV rLi 6 11 16 18 VLP vaccine (yeast) (lot#653937/0637F). Subsequ"ently Subsequently on approximately site that lasted approximately 60 to 90 seconds and her arm became red and painful enough to cause the patient to cry. The patient subsequently recovered from the pain in the extremity, erythema, and injection site irritation. Add Additional information has been requested. The registered nurse also reported that the patient''s sister experienced pain in the extremity, erythema,and injection site irritation following vaccination with HPV rLi 6 11 16 18 VLP vaccine (yeast) (lot#653937/0637F).


Changed on 9/14/2017

263229 Before After
VAERS Form:(blank) 1
Age:17.0
Gender:Female
Location:Texas
Vaccinated:2006-07-19
Onset:2006-07-19
Submitted:2006-09-14
Entered:2006-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / 0 1 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Erythema, Pain

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: Unknown
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0608USA06310

Write-up:Information has been received from a registered nurse concerning a 17 year old female with no medical history who on 19-JUL-2006 was vaccinated in the right deltoid with the first dose of HPV rLi 6 11 16 18 VLP vaccine (yeast) (lot#653937/0637F). Subsequently on approximately site that lasted approximately 60 to 90 seconds and her arm became red and painful enough to cause the patient to cry. The patient subsequently recovered from the pain in the extremity, erythema, and injection site irritation. Additional information has been requested. The registered nurse also reported that the patient''s sister experienced pain in the extremity, erythema,and injection site irritation following vaccination with HPV rLi 6 11 16 18 VLP vaccine (yeast) (lot#653937/0637F).


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