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This is VAERS ID 264066

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 264066
Age:16.0
Gender:Female
Location:Wisconsin
Vaccinated:2006-09-25
Onset:2006-09-25
Submitted:2006-10-03
Entered:2006-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0637F / 0 RA / -
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, INC. U2108AA / 0 RA / -
TDAP: TDAP (ADACEL) / AVENTIS PASTEUR, INC. C2556AA / 0 LA / -

Administered by: Private      Purchased by: Unknown
Symptoms: Injection site induration, Injection site reaction, Injection site warmth

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac, Abilify, Lamictal.
Current Illness:
Preexisting Conditions: allergies, sinusitis, Bipolar disorder.
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up:2 separate reactions Tdap 6x4 1/2/" area hot to touch. Induration of biceps upper arm started day of injection given seen in office 9/28/06, Gardasil 3 1/2 x 3/" hot to touch started 3 days after shot for both ice and Ibuprophen.


Changed on 12/8/2009

VAERS ID: 264066 Before After
Age:16.0
Gender:Female
Location:Wisconsin
Vaccinated:2006-09-25
Onset:2006-09-25
Submitted:2006-10-03
Entered:2006-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. 0637F / 0 RA / -
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, INC. AVENTIS PASTEUR U2108AA / 0 RA / -
TDAP: TDAP (ADACEL) / AVENTIS PASTEUR, INC. AVENTIS PASTEUR C2556AA / 0 LA / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Injection site induration, Injection site reaction, Injection site warmth

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac, Abilify, Lamictal.
Current Illness:
Preexisting Conditions: allergies, sinusitis, Bipolar disorder.
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up:2 separate reactions Tdap 6x4 1/2/" 1/2" area hot to touch. Induration of biceps upper arm started day of injection given seen in office 9/28/06, Gardasil 3 1/2 x 3/" 3" hot to touch started 3 days after shot for both ice and Ibuprophen.


Changed on 4/7/2010

VAERS ID: 264066 Before After
Age:16.0
Gender:Female
Location:Wisconsin
Vaccinated:2006-09-25
Onset:2006-09-25
Submitted:2006-10-03
Entered:2006-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / 0 RA / -
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U2108AA / 0 RA / -
TDAP: TDAP (ADACEL) / AVENTIS PASTEUR C2556AA / 0 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Injection site induration, Injection site reaction, Injection site warmth

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac, Abilify, Lamictal.
Current Illness:
Preexisting Conditions: allergies, sinusitis, Bipolar disorder.
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up:2 separate reactions Tdap 6x4 1/2" area hot to touch. Induration of biceps upper arm started day of injection given seen in office 9/28/06, Gardasil 3 1/2 x 3" hot to touch started 3 days after shot for both ice and Ibuprophen.


Changed on 5/14/2017

VAERS ID: 264066 Before After
Age:16.0
Gender:Female
Location:Wisconsin
Vaccinated:2006-09-25
Onset:2006-09-25
Submitted:2006-10-03
Entered:2006-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / 0 RA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U2108AA / 0 RA / -
TDAP: TDAP (ADACEL) / AVENTIS PASTEUR SANOFI PASTEUR C2556AA / 0 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Injection site induration, Injection site reaction, Injection site warmth

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac, Abilify, Lamictal.
Current Illness:
Preexisting Conditions: allergies, sinusitis, Bipolar disorder.
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up:2 separate reactions Tdap 6x4 1/2" area hot to touch. Induration of biceps upper arm started day of injection given seen in office 9/28/06, Gardasil 3 1/2 x 3" hot to touch started 3 days after shot for both ice and Ibuprophen.


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