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This is VAERS ID 264755

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 264755
VAERS Form:
Age:25.0
Gender:Female
Location:Unknown
Vaccinated:2006-09-20
Onset:2006-09-21
Submitted:2006-10-13
Entered:2006-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 653650/0702F / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: LEXAPRO, RITALIN
Current Illness:
Preexisting Conditions: Concurrent conditions: connective tissue disorder, thrombocytopenia, depression, drug hypersensitivity
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: Information has been received from a medical assistant concerning a 25 year old female with connective tissue disorder, thrombocytopenia, depression and allergy to ZITHROMAX who on 20-SEP-2006 was vaccinated with HPV rL1 6 11 16 18 VLP vaccine (yeast) IM"in the deltoid described as /"pre-filled syringe one time./" Concomitant therapy included escitalopram oxalate (LEXAPRO) and methylphenidate HCl (RITALIN). On 21-SEP-2006 the patient experienced fever of 100 degrees F. The patient sought unspecified medic


Changed on 12/8/2009

VAERS ID: 264755 Before After
VAERS Form:
Age:25.0
Gender:Female
Location:Unknown
Vaccinated:2006-09-20
Onset:2006-09-21
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. 653650/0702F / - - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: LEXAPRO, RITALIN
Current Illness:
Preexisting Conditions: Concurrent conditions: connective tissue disorder, thrombocytopenia, depression, drug hypersensitivity
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': (blank) WAES0609USA05006

Write-up: Information has been received from a medical assistant concerning a 25 year old female with connective tissue disorder, thrombocytopenia, depression and allergy to ZITHROMAX who on 20-SEP-2006 was vaccinated with HPV rL1 6 11 16 18 VLP vaccine (yeast) IM"in IM in the deltoid described as /"pre-filled "pre-filled syringe one time./" time." Concomitant therapy included escitalopram oxalate (LEXAPRO) and methylphenidate HCl (RITALIN). On 21-SEP-2006 the patient experienced fever of 100 degrees F. The patient sought unspecified medic medical attention. The patient''s fever of 100 degrees F. persisted. Additional information has been requested.


Changed on 1/5/2010

VAERS ID: 264755 Before After
VAERS Form:
Age:25.0
Gender:Female
Location:Unknown
Vaccinated:2006-09-20
Onset:2006-09-21
Submitted:2006-10-13
Entered:2006-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 653650/0702F 0702F / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No 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: LEXAPRO, RITALIN
Current Illness:
Preexisting Conditions: Concurrent conditions: connective tissue disorder, thrombocytopenia, depression, drug hypersensitivity
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0609USA05006

Write-up: Information has been received from a medical assistant concerning a 25 year old female with connective tissue disorder, thrombocytopenia, depression and allergy to ZITHROMAX who on 20-SEP-2006 was vaccinated with HPV rL1 6 11 16 18 VLP vaccine (yeast) IM in the deltoid described as "pre-filled syringe one time." Concomitant therapy included escitalopram oxalate (LEXAPRO) and methylphenidate HCl (RITALIN). On 21-SEP-2006 the patient experienced fever of 100 degrees F. The patient sought unspecified medical attention. The patient''s fever of 100 degrees F. persisted. Additional information has been requested.


Changed on 6/14/2014

VAERS ID: 264755 Before After
VAERS Form:
Age:25.0
Gender:Female
Location:Unknown
Vaccinated:2006-09-20
Onset:2006-09-21
Submitted:2006-10-13
Entered:2006-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0702F / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: 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: LEXAPRO, RITALIN
Current Illness:
Preexisting Conditions: Concurrent conditions: connective tissue disorder, thrombocytopenia, depression, drug hypersensitivity
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0609USA05006

Write-up: Information has been received from a medical assistant concerning a 25 year old female with connective tissue disorder, thrombocytopenia, depression and allergy to ZITHROMAX who on 20-SEP-2006 was vaccinated with HPV rL1 6 11 16 18 VLP vaccine (yeast) IM in the deltoid described as "pre-filled syringe one time." Concomitant therapy included escitalopram oxalate (LEXAPRO) and methylphenidate HCl (RITALIN). On 21-SEP-2006 the patient experienced fever of 100 degrees F. The patient sought unspecified medical attention. The patient''s fever of 100 degrees F. persisted. Additional information has been requested.


Changed on 5/14/2017

VAERS ID: 264755 Before After
VAERS Form:
Age:25.0
Gender:Female
Location:Unknown
Vaccinated:2006-09-20
Onset:2006-09-21
Submitted:2006-10-13
Entered:2006-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0702F / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: 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: LEXAPRO, RITALIN
Current Illness:
Preexisting Conditions: Concurrent conditions: connective tissue disorder, thrombocytopenia, depression, drug hypersensitivity
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0609USA05006

Write-up: Information has been received from a medical assistant concerning a 25 year old female with connective tissue disorder, thrombocytopenia, depression and allergy to ZITHROMAX who on 20-SEP-2006 was vaccinated with HPV rL1 6 11 16 18 VLP vaccine (yeast) IM in the deltoid described as "pre-filled syringe one time." Concomitant therapy included escitalopram oxalate (LEXAPRO) and methylphenidate HCl (RITALIN). On 21-SEP-2006 the patient experienced fever of 100 degrees F. The patient sought unspecified medical attention. The patient''s fever of 100 degrees F. persisted. Additional information has been requested.


Changed on 9/14/2017

VAERS ID: 264755 Before After
VAERS Form:(blank) 1
Age:25.0
Gender:Female
Location:Unknown
Vaccinated:2006-09-20
Onset:2006-09-21
Submitted:2006-10-13
Entered:2006-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0702F / - UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: 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: LEXAPRO, RITALIN
Current Illness:
Preexisting Conditions: Concurrent conditions: connective tissue disorder, thrombocytopenia, depression, drug hypersensitivity
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0609USA05006

Write-up: Information has been received from a medical assistant concerning a 25 year old female with connective tissue disorder, thrombocytopenia, depression and allergy to ZITHROMAX who on 20-SEP-2006 was vaccinated with HPV rL1 6 11 16 18 VLP vaccine (yeast) IM in the deltoid described as "pre-filled syringe one time." Concomitant therapy included escitalopram oxalate (LEXAPRO) and methylphenidate HCl (RITALIN). On 21-SEP-2006 the patient experienced fever of 100 degrees F. The patient sought unspecified medical attention. The patient''s fever of 100 degrees F. persisted. Additional information has been requested.


Changed on 2/14/2018

VAERS ID: 264755 Before After
VAERS Form:1
Age:25.0
Gender:Female
Location:Unknown
Vaccinated:2006-09-20
Onset:2006-09-21
Submitted:2006-10-13
Entered:2006-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0702F / UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: 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: LEXAPRO, RITALIN
Current Illness:
Preexisting Conditions: Concurrent conditions: connective tissue disorder, thrombocytopenia, depression, drug hypersensitivity
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0609USA05006

Write-up: Information has been received from a medical assistant concerning a 25 year old female with connective tissue disorder, thrombocytopenia, depression and allergy to ZITHROMAX who on 20-SEP-2006 was vaccinated with HPV rL1 6 11 16 18 VLP vaccine (yeast) IM in the deltoid described as "pre-filled syringe one time." Concomitant therapy included escitalopram oxalate (LEXAPRO) and methylphenidate HCl (RITALIN). On 21-SEP-2006 the patient experienced fever of 100 degrees F. The patient sought unspecified medical attention. The patient''s fever of 100 degrees F. persisted. Additional information has been requested.

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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=264755&WAYBACKHISTORY=ON


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