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From the 1/14/2022 release of VAERS data:

This is VAERS ID 264376

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Case Details

VAERS ID: 264376 (history)  
Form: Version 1.0  
Age: 22.0  
Sex: Female  
Location: Arizona  
   Days after vaccination:3
Submitted: 2006-10-06
   Days after onset:34
Entered: 2006-10-11
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Private
Symptoms: Abdominal discomfort, Aphthous stomatitis, Herpes simplex, Malaise, Myalgia, Nausea, Pharyngolaryngeal pain, Pyrexia, Skin ulcer, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: Herpes simplex virus, 09/13/06, Oral T 1 +; Herpes simplex virus, 09/13/06, Finger T 1 +; body temp, 09/06/06, 102F; body temp 09/08/06, 98.9F.
CDC Split Type: WAES0609USA01979

Write-up: Information has been received from a physician concerning a 22 year old female with no pertinent medical history and no allergies, who on 8/30/06 was vaccinated with HPV rL1 6 11 16 18 VLP vaccine yeast. On 9/2/06 the pt developed a canker sore on her lip and sore throat. On 9/6/06 she experienced nausea, vomiting, malaise, a temperature of 102F and developed a herpetic ulcerative ring on her left ring finger. It was also reported that the pt experienced myalgia. Unspecified medical attention was sought/ Subsequently, it was reported on 9/8/06 that the symptoms were subsiding, the lesion on the pts lip had crusted and her temp was 98.9F. 01/05/2007 Follow up information received stated that on 02-SEP-2006 the patient also developed gastrointestinal upset. Lab work completed on 13-SEP-06 included positive cultures for Herpes simplex type 1 isolated in oral swab and on the patients finger. At the time of this report it was unknown if the patient had recovered from the event. Additional information has been requested.

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