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This is VAERS ID 263862

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 263862
VAERS Form:
Age:15.0
Gender:Female
Location:Illinois
Vaccinated:2006-09-28
Onset:2006-09-29
Submitted:2006-10-02
Entered:2006-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0702F / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Anorexia, Back pain, Fatigue, Headache, Pyrexia

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

Write-up: Fatigue, Headache, Backaches, Temp 103, no appetite, x 3 days then was ok no treatment.


Changed on 12/8/2009

VAERS ID: 263862 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Illinois
Vaccinated:2006-09-28
Onset:2006-09-29
Submitted:2006-10-02
Entered:2006-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. 0702F / 0 LA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Anorexia, Back pain, Fatigue, Headache, Pyrexia

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

Write-up: Fatigue, Headache, Backaches, Temp 103, no appetite, x 3 days then was ok no treatment.


Changed on 9/14/2017

VAERS ID: 263862 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:Illinois
Vaccinated:2006-09-28
Onset:2006-09-29
Submitted:2006-10-02
Entered:2006-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0702F / 0 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Back pain, Fatigue, Headache, Pyrexia

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

Write-up: Fatigue, Headache, Backaches, Temp 103, no appetite, x 3 days then was ok no treatment.


Changed on 2/14/2018

VAERS ID: 263862 Before After
VAERS Form:1
Age:15.0
Gender:Female
Location:Illinois
Vaccinated:2006-09-28
Onset:2006-09-29
Submitted:2006-10-02
Entered:2006-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0702F / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Anorexia, Back pain, Fatigue, Headache, Pyrexia

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

Write-up: Fatigue, Headache, Backaches, Temp 103, no appetite, x 3 days then was ok no treatment.


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