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This is VAERS ID 264748

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 264748
Age:20.0
Gender: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
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: MICROGESTIN FE
Current Illness:
Preexisting Conditions: Sulfonamide allergy
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


Changed on 12/8/2009

VAERS ID: 264748 Before After
Age:20.0
Gender: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) HPV (GARDASIL) / MERCK & CO. INC. 0641F / 0 - / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Pain, Pyrexia

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: MICROGESTIN FE
Current Illness:
Preexisting Conditions: Sulfonamide allergy
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.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=264748&WAYBACKHISTORY=ON


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