National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 264066

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

264066
VAERS Form:
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
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: Prozac, Abilify, Lamictal.
Current Illness:
Preexisting Conditions: allergies, sinusitis, Bipolar disorder.
Allergies:
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

264066 Before After
VAERS Form:
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
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: Prozac, Abilify, Lamictal.
Current Illness:
Preexisting Conditions: allergies, sinusitis, Bipolar disorder.
Allergies:
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

264066 Before After
VAERS Form:
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
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: Prozac, Abilify, Lamictal.
Current Illness:
Preexisting Conditions: allergies, sinusitis, Bipolar disorder.
Allergies:
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

264066 Before After
VAERS Form:
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
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: Prozac, Abilify, Lamictal.
Current Illness:
Preexisting Conditions: allergies, sinusitis, Bipolar disorder.
Allergies:
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 9/14/2017

264066 Before After
VAERS Form:(blank) 1
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 1 RA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2108AA / 0 1 RA / -
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2556AA / 0 1 LA / -

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

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: Prozac, Abilify, Lamictal.
Current Illness:
Preexisting Conditions: allergies, sinusitis, Bipolar disorder.
Allergies:
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.


New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=264066&WAYBACKHISTORY=ON


Copyright © 2017 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166