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This is VAERS ID 264556

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 264556
VAERS Form:
Age:16.0
Gender:Female
Location:Indiana
Vaccinated:2006-10-05
Onset:2006-10-05
Submitted:2006-10-13
Entered:2006-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUZONE) / AVENTIS PASTEUR, INC. U2239AA / 1 LA / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0223F / 1 LA / -
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0955F / 0 RA / -

Administered by: Private      Purchased by: Unknown
Symptoms: Injection site pain

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Pain in right upper arm from time of administration of vaccine and continuing 8 days.

Changed on 12/8/2009

VAERS ID: 264556 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Indiana
Vaccinated:2006-10-05
Onset:2006-10-05
Submitted:2006-10-13
Entered:2006-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUZONE) INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR, INC. AVENTIS PASTEUR U2239AA / 1 LA / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0223F / 1 LA / -
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. 0955F / 0 RA / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Injection site pain

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Pain in right upper arm from time of administration of vaccine and continuing 8 days.

Changed on 7/7/2013

VAERS ID: 264556 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Indiana
Vaccinated:2006-10-05
Onset:2006-10-05
Submitted:2006-10-13
Entered:2006-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U2239AA / 1 LA / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U2239AA / 1 LA / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0223F / 1 LA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 0 RA / -

Administered by: Private      Purchased by: Private
Symptoms: Injection site pain

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Pain in right upper arm from time of administration of vaccine and continuing 8 days.

Changed on 5/14/2017

VAERS ID: 264556 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Indiana
Vaccinated:2006-10-05
Onset:2006-10-05
Submitted:2006-10-13
Entered:2006-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR SANOFI PASTEUR U2239AA / 1 LA / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0223F / 1 LA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 0 RA / -

Administered by: Private      Purchased by: Private
Symptoms: Injection site pain

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Pain in right upper arm from time of administration of vaccine and continuing 8 days.

Changed on 9/14/2017

VAERS ID: 264556 Before After
VAERS Form:(blank) 1
Age:16.0
Gender:Female
Location:Indiana
Vaccinated:2006-10-05
Onset:2006-10-05
Submitted:2006-10-13
Entered:2006-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2239AA / 1 2 LA / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0223F / 1 2 LA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 0 1 RA / -

Administered by: Private      Purchased by: Private
Symptoms: Injection site pain

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Pain in right upper arm from time of administration of vaccine and continuing 8 days.

Changed on 2/14/2018

VAERS ID: 264556 Before After
VAERS Form:1
Age:16.0
Gender:Female
Location:Indiana
Vaccinated:2006-10-05
Onset:2006-10-05
Submitted:2006-10-13
Entered:2006-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2239AA / 2 LA / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0223F / 2 LA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 1 RA / -

Administered by: Private      Purchased by: Private
Symptoms: Injection site pain

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Pain in right upper arm from time of administration of vaccine and continuing 8 days.

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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=264556&WAYBACKHISTORY=ON


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