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This is VAERS ID 263612

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

263612
VAERS Form:
Age:18.0
Gender:Female
Location:North Carolina
Vaccinated:2006-09-01
Onset:2006-09-08
Submitted:2006-09-25
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0637F / 0 LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Blister, Erythema, Hypersensitivity, Rash erythematous

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: Singular, Zyrtec
Current Illness: NONE
Preexisting Conditions: Seasonal allergic rhinitis.
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up:Raised erythematous patchy rash of left shoulder (Behind left deltoid muscle) with slight vesicles. Also similar linear rash on left leg (appearance of delayed hypersensitivity) rash began 1 week after injection.


Changed on 12/8/2009

263612 Before After
VAERS Form:
Age:18.0
Gender:Female
Location:North Carolina
Vaccinated:2006-09-01
Onset:2006-09-08
Submitted:2006-09-25
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. 0637F / 0 LA / IM

Administered by: Other      Purchased by: Unknown Private
Symptoms: Blister, Erythema, Hypersensitivity, Rash erythematous

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: Singular, Zyrtec
Current Illness: NONE
Preexisting Conditions: Seasonal allergic rhinitis.
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up:Raised erythematous patchy rash of left shoulder (Behind left deltoid muscle) with slight vesicles. Also similar linear rash on left leg (appearance of delayed hypersensitivity) rash began 1 week after injection.


Changed on 9/14/2017

263612 Before After
VAERS Form:(blank) 1
Age:18.0
Gender:Female
Location:North Carolina
Vaccinated:2006-09-01
Onset:2006-09-08
Submitted:2006-09-25
Entered:2006-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / 0 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Blister, Erythema, Hypersensitivity, Rash erythematous

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: Singular, Zyrtec
Current Illness: NONE
Preexisting Conditions: Seasonal allergic rhinitis.
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up:Raised erythematous patchy rash of left shoulder (Behind left deltoid muscle) with slight vesicles. Also similar linear rash on left leg (appearance of delayed hypersensitivity) rash began 1 week after injection.


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