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This is VAERS ID 264757

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

264757
VAERS Form:
Age:25.0
Gender:Female
Location:Missouri
Vaccinated:2006-09-01
Onset:2006-09-08
Submitted:2006-10-13
Entered:2006-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 653937/0637F / - - / IM

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

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

Write-up:Information has been received from a physician and a registered nurse concerning a 25 year old female who on 01-SEP-2006 was vaccinated IM with a 0.5 ml dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). Concomitant therapy included hormonal contraceptives ("unspecified). On approximately 08-SEP-2006, one week after vaccination, the patient developed /"small bumps under her skin/" at the injection site. The patient sought unspecified medical attention. Subsequently, the patient fully recovered.


Changed on 12/8/2009

264757 Before After
VAERS Form:
Age:25.0
Gender:Female
Location:Missouri
Vaccinated:2006-09-01
Onset:2006-09-08
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. 653937/0637F / - - / IM

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

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: hormonal contraception
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': (blank) WAES0609USA05017

Write-up:Information has been received from a physician and a registered nurse concerning a 25 year old female who on 01-SEP-2006 was vaccinated IM with a 0.5 ml dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). Concomitant therapy included hormonal contraceptives ("unspecified). (unspecified). On approximately 08-SEP-2006, one week after vaccination, the patient developed /"small "small bumps under her skin/" skin" at the injection site. The patient sought unspecified medical attention. Subsequently, the patient fully recovered.


Changed on 9/14/2017

264757 Before After
VAERS Form:(blank) 1
Age:25.0
Gender:Female
Location:Missouri
Vaccinated:2006-09-01
Onset:2006-09-08
Submitted:2006-10-13
Entered:2006-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 653937/0637F / - UNK - / IM

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

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: hormonal contraception
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0609USA05017

Write-up:Information has been received from a physician and a registered nurse concerning a 25 year old female who on 01-SEP-2006 was vaccinated IM with a 0.5 ml dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). Concomitant therapy included hormonal contraceptives (unspecified). On approximately 08-SEP-2006, one week after vaccination, the patient developed "small bumps under her skin" at the injection site. The patient sought unspecified medical attention. Subsequently, the patient fully recovered.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=264757&WAYBACKHISTORY=ON


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