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VAERS ID: | 264748 |
VAERS Form: | |
Age: | 20.0 |
Sex: | Female |
Location: | Indiana |
Vaccinated: | 2006-09-12 |
Onset: | 2006-09-13 |
Submitted: | 2006-10-13 |
Entered: | 2006-10-17 |
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
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: 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
Vaccinated: | 2006-09-12 |
Onset: | 2006-09-13 |
Submitted: | 2006-10-13 |
Entered: | 2006-10-17 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. | 0641F / 0 | - / IM |
Administered by: Private Purchased by: Unknown Private
Symptoms: Pain, Pyrexia
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: MICROGESTIN FE
Current Illness:
Preexisting Conditions: Sulfonamide allergy
Allergies:
Diagnostic Lab Data: Body temp 09/13/06 103.6 degr
CDC 'Split Type': (blank) WAES0609USA03694
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 vaccine (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 aches. Medical attention was sought. On 18-SEP-2006, the patient recovered. Additional information is not expected.
Vaccinated: | 2006-09-12 |
Onset: | 2006-09-13 |
Submitted: | 2006-10-13 |
Entered: | 2006-10-17 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. | 0641F / 0 1 | - / IM |
Administered by: Private Purchased by: Private
Symptoms: Pain, Pyrexia
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: MICROGESTIN FE
Current Illness:
Preexisting Conditions: Sulfonamide allergy
Allergies:
Diagnostic Lab Data: Body temp 09/13/06 103.6 degr
CDC 'Split Type': WAES0609USA03694
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 vaccine (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. Medical attention was sought. On 18-SEP-2006, the patient recovered. Additional information is not expected.
Vaccinated: | 2006-09-12 |
Onset: | 2006-09-13 |
Submitted: | 2006-10-13 |
Entered: | 2006-10-17 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. | 0641F / 1 | - / IM |
Administered by: Private Purchased by: Private
Symptoms: Pain, Pyrexia
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: MICROGESTIN FE
Current Illness:
Preexisting Conditions: Sulfonamide allergy
Allergies:
Diagnostic Lab Data: Body temp 09/13/06 103.6 degr
CDC 'Split Type': WAES0609USA03694
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 vaccine (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. Medical attention was sought. On 18-SEP-2006, the patient recovered. Additional information is not expected.
Vaccinated: | 2006-09-12 |
Onset: | 2006-09-13 |
Submitted: | 2006-10-13 |
Entered: | 2006-10-17 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. | 0641F / 1 | - / IM |
Administered by: Private Purchased by: Private
Symptoms: Pain, Pyrexia
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: MICROGESTIN FE
Current Illness:
Preexisting Conditions: Sulfonamide allergy
Allergies:
Diagnostic Lab Data: Body temp 09/13/06 103.6 degr
CDC 'Split Type': WAES0609USA03694
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 vaccine (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. Medical attention was sought. On 18-SEP-2006, the patient recovered. Additional information is not expected.
Vaccinated: | 2006-09-12 |
Onset: | 2006-09-13 |
Submitted: | 2006-10-13 |
Entered: | 2006-10-17 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. | 0641F / 1 | - / IM |
Administered by: Private Purchased by: Private
Symptoms: Pain, Pyrexia
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: MICROGESTIN FE
Current Illness:
Preexisting Conditions: Sulfonamide allergy
Allergies:
Diagnostic Lab Data: Body temp 09/13/06 103.6 degr
CDC 'Split Type': WAES0609USA03694
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 vaccine (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. Medical attention was sought. On 18-SEP-2006, the patient recovered. Additional information is not expected.
Vaccinated: | 2006-09-12 |
Onset: | 2006-09-13 |
Submitted: | 2006-10-13 |
Entered: | 2006-10-17 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. | 0641F / 1 | - / IM |
Administered by: Private Purchased by: Private
Symptoms: Pain, Pyrexia
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: MICROGESTIN FE
Current Illness:
Preexisting Conditions: Sulfonamide allergy
Allergies:
Diagnostic Lab Data: Body temp 09/13/06 103.6 degr
CDC 'Split Type': WAES0609USA03694
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 vaccine (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. Medical attention was sought. On 18-SEP-2006, the patient recovered. Additional information is not expected.
Vaccinated: | 2006-09-12 |
Onset: | 2006-09-13 |
Submitted: | 2006-10-13 |
Entered: | 2006-10-17 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. | 0641F / 1 | - / IM |
Administered by: Private Purchased by: Private
Symptoms: Pain, Pyrexia
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: MICROGESTIN FE
Current Illness:
Preexisting Conditions: Sulfonamide allergy
Allergies:
Diagnostic Lab Data: Body temp 09/13/06 103.6 degr
CDC 'Split Type': WAES0609USA03694
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 vaccine (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. Medical attention was sought. On 18-SEP-2006, the patient recovered. Additional information is not expected.
Vaccinated: | 2006-09-12 |
Onset: | 2006-09-13 |
Submitted: | 2006-10-13 |
Entered: | 2006-10-17 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. | 0641F / 1 | - / IM |
Administered by: Private Purchased by: Private
Symptoms: Pain, Pyrexia
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: MICROGESTIN FE
Current Illness:
Preexisting Conditions: Sulfonamide allergy
Allergies:
Diagnostic Lab Data: Body temp 09/13/06 103.6 degr
CDC 'Split Type': WAES0609USA03694
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 vaccine (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. Medical attention was sought. On 18-SEP-2006, the patient recovered. Additional information is not expected.
Vaccinated: | 2006-09-12 |
Onset: | 2006-09-13 |
Submitted: | 2006-10-13 |
Entered: | 2006-10-17 |
Vaccination / Manufacturer | Lot / Dose | Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. | 0641F / 1 | - / IM |
Administered by: Private Purchased by: Private
Symptoms: Pain, Pyrexia
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: MICROGESTIN FE
Current Illness:
Preexisting Conditions: Sulfonamide allergy
Allergies:
Diagnostic Lab Data: Body temp 09/13/06 103.6 degr
CDC 'Split Type': WAES0609USA03694
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 vaccine (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. Medical attention was sought. On 18-SEP-2006, the patient recovered. Additional information is not expected.
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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=264748&WAYBACKHISTORY=ON
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