This is VAERS ID 264753

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID:	264753
VAERS Form:
Age:	18.0
Gender:	Female
Location:	Pennsylvania

Vaccinated:	2006-09-11
Onset:	2006-09-12
Submitted:	2006-10-13
Entered:	2006-10-17

Vaccination / Manufacturer	Lot / Dose	Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC.	653735/0688F / -	- / IM

Administered by: Other Purchased by: Unknown
Symptoms: Pyrexia, Rash vesicular

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: NONE
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 17 year old female with no history of varicella virus vaccine live vaccination and an unknown history of varicella, who on 11-SEP-2006 was vaccinated intramuscularly with a 0.5 ml dose of HPV rL1"6 11 16 18 VLP vaccine (yeast). There was no concomitant medication. The physician reported that on 12-SEP-2006 /"the next day, the patient developed a low grade fever and a vesicular rash on her neck and shoulders of about 15-20 lesions./" The patient wa

Changed on 12/8/2009

VAERS ID:	264753 Before After
VAERS Form:
Age:	18.0
Gender:	Female
Location:	Pennsylvania

Vaccinated:	2006-09-11
Onset:	2006-09-12
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.	653735/0688F / -	- / IM

Administered by: Other Purchased by: Unknown Other
Symptoms: Pyrexia, Rash vesicular

Write-up: Information has been received from a physician concerning a 17 year old female with no history of varicella virus vaccine live vaccination and an unknown history of varicella, who on 11-SEP-2006 was vaccinated intramuscularly with a 0.5 ml dose of HPV rL1"6 rL1 6 11 16 18 VLP vaccine (yeast). There was no concomitant medication. The physician reported that on 12-SEP-2006 /"the "the next day, the patient developed a low grade fever and a vesicular rash on her neck and shoulders of about 15-20 lesions./" lesions." The patient wa was treated with acetaminophen (TYLENOL). All of her symptoms resolved within 3-4 days (approximately 15-SEP-2006). Additional information has been requested.

Changed on 9/14/2017

VAERS ID:	264753 Before After
VAERS Form:	(blank) 1
Age:	18.0
Gender:	Female
Location:	Pennsylvania

Vaccinated:	2006-09-11
Onset:	2006-09-12
Submitted:	2006-10-13
Entered:	2006-10-17

Vaccination / Manufacturer	Lot / Dose	Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC.	653735/0688F / - UNK	- / IM

Administered by: Other Purchased by: Other
Symptoms: Pyrexia, Rash vesicular

Write-up: Information has been received from a physician concerning a 17 year old female with no history of varicella virus vaccine live vaccination and an unknown history of varicella, who on 11-SEP-2006 was vaccinated intramuscularly with a 0.5 ml dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). There was no concomitant medication. The physician reported that on 12-SEP-2006 "the next day, the patient developed a low grade fever and a vesicular rash on her neck and shoulders of about 15-20 lesions." The patient was treated with acetaminophen (TYLENOL). All of her symptoms resolved within 3-4 days (approximately 15-SEP-2006). Additional information has been requested.

Changed on 2/14/2018

VAERS ID:	264753 Before After
VAERS Form:	1
Age:	18.0
Gender:	Female
Location:	Pennsylvania

Vaccinated:	2006-09-11
Onset:	2006-09-12
Submitted:	2006-10-13
Entered:	2006-10-17

Vaccination / Manufacturer	Lot / Dose	Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC.	653735/0688F / UNK	- / IM

Administered by: Other Purchased by: Other
Symptoms: Pyrexia, Rash vesicular

Write-up: Information has been received from a physician concerning a 17 year old female with no history of varicella virus vaccine live vaccination and an unknown history of varicella, who on 11-SEP-2006 was vaccinated intramuscularly with a 0.5 ml dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). There was no concomitant medication. The physician reported that on 12-SEP-2006 "the next day, the patient developed a low grade fever and a vesicular rash on her neck and shoulders of about 15-20 lesions." The patient was treated with acetaminophen (TYLENOL). All of her symptoms resolved within 3-4 days (approximately 15-SEP-2006). Additional information has been requested.

Changed on 6/14/2018

VAERS ID:	264753 Before After
VAERS Form:	1
Age:	18.0
Gender:	Female
Location:	Pennsylvania

Vaccinated:	2006-09-11
Onset:	2006-09-12
Submitted:	2006-10-13
Entered:	2006-10-17

Vaccination / Manufacturer	Lot / Dose	Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC.	653735/0688F / UNK	- / IM

Administered by: Other Purchased by: Other
Symptoms: Pyrexia, Rash vesicular

Write-up: Information has been received from a physician concerning a 17 year old female with no history of varicella virus vaccine live vaccination and an unknown history of varicella, who on 11-SEP-2006 was vaccinated intramuscularly with a 0.5 ml dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). There was no concomitant medication. The physician reported that on 12-SEP-2006 "the next day, the patient developed a low grade fever and a vesicular rash on her neck and shoulders of about 15-20 lesions." The patient was treated with acetaminophen (TYLENOL). All of her symptoms resolved within 3-4 days (approximately 15-SEP-2006). Additional information has been requested.

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