This is VAERS ID 264748

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID:	264748
VAERS Form:
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
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

Changed on 12/8/2009

VAERS ID:	264748 Before After
VAERS Form:
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

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.

Changed on 9/14/2017

VAERS ID:	264748 Before After
VAERS Form:	(blank) 1
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: HPV (GARDASIL) / MERCK & CO. INC.	0641F / 0 1	- / IM

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

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.

Changed on 2/14/2018

VAERS ID:	264748 Before After
VAERS Form:	1
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: HPV (GARDASIL) / MERCK & CO. INC.	0641F / 1	- / IM

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

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.

Changed on 6/14/2018

VAERS ID:	264748 Before After
VAERS Form:	1
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: HPV (GARDASIL) / MERCK & CO. INC.	0641F / 1	- / IM

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

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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