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This is VAERS ID 264756

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

264756
VAERS Form:
Age:
Gender:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2006-10-13
Entered:2006-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. - / - - / -

Administered by: Other      Purchased by: Unknown
Symptoms: Injection site reaction

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

Write-up:Information has been received from a nurse practitioner concerning a female who on 18-SEP-2006 was vaccinated with HPV rL1 6 11 16 18 VLP vaccine (yeast). Subsequently the patient experienced injection site reaction. The patient sought unspecified medical"attention. Injection site reaction persists. Additional information has been requested.


Changed on 12/8/2009

264756 Before After
VAERS Form:
Age:
Gender:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
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. - / - - / -

Administered by: Other      Purchased by: Unknown Other
Symptoms: Injection site reaction

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: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': (blank) WAES0609USA05009

Write-up:Information has been received from a nurse practitioner concerning a female who on 18-SEP-2006 was vaccinated with HPV rL1 6 11 16 18 VLP vaccine (yeast). Subsequently the patient experienced injection site reaction. The patient sought unspecified medical"attention. medical attention. Injection site reaction persists. Additional information has been requested.


Changed on 1/5/2010

264756 Before After
VAERS Form:
Age:(blank) 23.0
Gender:Female
Location:Unknown
Vaccinated:0000-00-00 2006-09-18
Onset:0000-00-00 2006-09-18
Submitted:2006-10-13
Entered:2006-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - 0637F / - - UN / - IM

Administered by: Other      Purchased by: Other
Symptoms: Injection site reaction

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: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0609USA05009

Write-up:Information has been received from a nurse practitioner concerning a female who on 18-SEP-2006 was vaccinated with HPV rL1 6 11 16 18 VLP vaccine (yeast). Subsequently the patient experienced injection site reaction. The patient sought unspecified medical attention. Injection site reaction persists. Additional information has been requested.


Changed on 6/14/2014

264756 Before After
VAERS Form:
Age:23.0
Gender:Female
Location:Unknown
Vaccinated:2006-09-18
Onset:2006-09-18
Submitted:2006-10-13
Entered:2006-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / - UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Injection site reaction

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: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0609USA05009

Write-up:Information has been received from a nurse practitioner concerning a female who on 18-SEP-2006 was vaccinated with HPV rL1 6 11 16 18 VLP vaccine (yeast). Subsequently the patient experienced injection site reaction. The patient sought unspecified medical attention. Injection site reaction persists. Additional information has been requested.


Changed on 3/14/2015

264756 Before After
VAERS Form:
Age:23.0
Gender:Female
Location:Unknown
Vaccinated:2006-09-18
Onset:2006-09-18
Submitted:2006-10-13
Entered:2006-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / - UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Injection site reaction

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: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0609USA05009

Write-up:Information has been received from a nurse practitioner concerning a female who on 18-SEP-2006 was vaccinated with HPV rL1 6 11 16 18 VLP vaccine (yeast). Subsequently the patient experienced injection site reaction. The patient sought unspecified medical attention. Injection site reaction persists. Additional information has been requested.


Changed on 9/14/2017

264756 Before After
VAERS Form:(blank) 1
Age:23.0
Gender:Female
Location:Unknown
Vaccinated:2006-09-18
Onset:2006-09-18
Submitted:2006-10-13
Entered:2006-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / - UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Injection site reaction

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: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0609USA05009

Write-up:Information has been received from a nurse practitioner concerning a female who on 18-SEP-2006 was vaccinated with HPV rL1 6 11 16 18 VLP vaccine (yeast). Subsequently the patient experienced injection site reaction. The patient sought unspecified medical attention. Injection site reaction persists. Additional information has been requested.


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