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This is VAERS ID 264172

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

264172
VAERS Form:
Age:17.0
Gender:Female
Location:California
Vaccinated:2006-10-02
Onset:2006-10-06
Submitted:2006-10-09
Entered:2006-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0637F / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, INC. U2114AA / 0 LA / IM
TDAP: TDAP (ADACEL) / AVENTIS PASTEUR, INC. C2559BA / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Pruritus, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Urticaria (hives) developed 4 days after vaccines were given covered torso and extremities, extremely itchy. Pt was given Benadryl Zyrtec, Prednisone orally and took a bath with baking soda.


Changed on 12/8/2009

264172 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:California
Vaccinated:2006-10-02
Onset:2006-10-06
Submitted:2006-10-09
Entered:2006-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. 0637F / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, INC. AVENTIS PASTEUR U2114AA / 0 LA / IM
TDAP: TDAP (ADACEL) / AVENTIS PASTEUR, INC. AVENTIS PASTEUR C2559BA / 0 LA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Pruritus, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Urticaria (hives) developed 4 days after vaccines were given covered torso and extremities, extremely itchy. Pt was given Benadryl Zyrtec, Prednisone orally and took a bath with baking soda.


Changed on 4/7/2010

264172 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:California
Vaccinated:2006-10-02
Onset:2006-10-06
Submitted:2006-10-09
Entered:2006-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U2114AA / 0 LA / IM
TDAP: TDAP (ADACEL) / AVENTIS PASTEUR C2559BA / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Pruritus, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Urticaria (hives) developed 4 days after vaccines were given covered torso and extremities, extremely itchy. Pt was given Benadryl Zyrtec, Prednisone orally and took a bath with baking soda.


Changed on 5/14/2017

264172 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:California
Vaccinated:2006-10-02
Onset:2006-10-06
Submitted:2006-10-09
Entered:2006-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U2114AA / 0 LA / IM
TDAP: TDAP (ADACEL) / AVENTIS PASTEUR SANOFI PASTEUR C2559BA / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Pruritus, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Urticaria (hives) developed 4 days after vaccines were given covered torso and extremities, extremely itchy. Pt was given Benadryl Zyrtec, Prednisone orally and took a bath with baking soda.


Changed on 9/14/2017

264172 Before After
VAERS Form:(blank) 1
Age:17.0
Gender:Female
Location:California
Vaccinated:2006-10-02
Onset:2006-10-06
Submitted:2006-10-09
Entered:2006-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / 0 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2114AA / 0 1 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2559BA / 0 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Pruritus, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Urticaria (hives) developed 4 days after vaccines were given covered torso and extremities, extremely itchy. Pt was given Benadryl Zyrtec, Prednisone orally and took a bath with baking soda.


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