National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 264748

(NOTE: This result is from the 12/30/2006 version of the VAERS database)

Case Details

VAERS ID: 264748 (history)  
Form: Version .0  
Age: 20.0  
Gender: Female  
Location: Indiana  
Vaccinated:2006-09-12
Onset:2006-09-13
   Days after vaccination:1
Submitted: 2006-10-13
   Days after onset:30
Entered: 2006-10-17
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0641F / 0 - / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MICROGESTIN FE
Current Illness:
Preexisting Conditions: Sulfonamide allergy
Allergies:
Diagnostic Lab Data: Body temp 09/13/06 103.6 degr
CDC Split Type:

Write-up: Initial and follow up information has been received from a physician concerning a 20 year old female patient with sulfonamide allergy who on 12-SEP-2006 at 13:45 p.m. was vaccinated IM in the left deltoid with her first dose of HPV rL1 6 11 16 18 VLP vacc"ine (yeast), lot #653650/0641. Concomitant therapy included ethinyl estradiol (+) ferrous fumarate (+) norethindrone acetate (MICROGESTIN FE). On the early morning of 13-SEP-2006 the patient developed a fever to 103.6 degrees F, and generalized body aches


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20061230&IDNUMBER=264748


Copyright © 2018 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166