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This is VAERS ID 263751

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

263751
VAERS Form:
Age:20.0
Gender:Female
Location:New York
Vaccinated:2006-08-25
Onset:2006-08-26
Submitted:2000-09-26
Entered:2006-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0688F / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Injection site reaction, Rash

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: Yasmin
Current Illness: NONE
Preexisting Conditions: possible polycystic ovary syndrome
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up:Rash at injection site at 24 hours after administration, then rash on other arm (at corresponding site)


Changed on 12/8/2009

263751 Before After
VAERS Form:
Age:20.0
Gender:Female
Location:New York
Vaccinated:2006-08-25
Onset:2006-08-26
Submitted:2000-09-26
Entered:2006-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. 0688F / 0 LA / IM

Administered by: Private      Purchased by: Unknown Other
Symptoms: Injection site reaction, Rash

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: Yasmin
Current Illness: NONE
Preexisting Conditions: possible polycystic ovary syndrome
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up:Rash at injection site at 24 hours after administration, then rash on other arm (at corresponding site)


Changed on 9/14/2017

263751 Before After
VAERS Form:(blank) 1
Age:20.0
Gender:Female
Location:New York
Vaccinated:2006-08-25
Onset:2006-08-26
Submitted:2000-09-26
Entered:2006-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0688F / 0 1 LA / IM

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

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: Yasmin
Current Illness: NONE
Preexisting Conditions: possible polycystic ovary syndrome
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up:Rash at injection site at 24 hours after administration, then rash on other arm (at corresponding site)


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