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This is VAERS ID 264763

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 264763
VAERS Form:
Age:17.0
Gender:Female
Location:Indiana
Vaccinated:2006-09-22
Onset:2006-09-22
Submitted:2006-10-13
Entered:2006-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. - / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Lymphadenopathy, Pyrexia, Injection site swelling

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: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up: Information has been received from a physician concerning a 17 year old female patient who on 22-SEP-2006 was vaccinated IM with a first 0.5 ml dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). There was no concomitant medication. On 22-SEP-2006 the patient"developed swollen lymph nodes in the neck and groin, swelling at injection site and low grade fever. The patient sought unspecified medical attention. It was reported that the patient was recovering. Additional information has been requested.

Changed on 12/8/2009

VAERS ID: 264763 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Indiana
Vaccinated:2006-09-22
Onset:2006-09-22
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. - / - - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Lymphadenopathy, Pyrexia, Injection site swelling

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: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': (blank) WAES0609USA07045

Write-up: Information has been received from a physician concerning a 17 year old female patient who on 22-SEP-2006 was vaccinated IM with a first 0.5 ml dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). There was no concomitant medication. On 22-SEP-2006 the patient"developed patient developed swollen lymph nodes in the neck and groin, swelling at injection site and low grade fever. The patient sought unspecified medical attention. It was reported that the patient was recovering. Additional information has been requested.

Changed on 3/14/2014

VAERS ID: 264763 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Indiana
Vaccinated:2006-09-22
Onset:2006-09-22
Submitted:2006-10-13
Entered:2006-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - - UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Lymphadenopathy, Pyrexia, Injection site swelling

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: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0609USA07045

Write-up: Information has been received from a physician concerning a 17 year old female patient who on 22-SEP-2006 was vaccinated IM with a first 0.5 ml dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). There was no concomitant medication. On 22-SEP-2006 the patient developed swollen lymph nodes in the neck and groin, swelling at injection site and low grade fever. The patient sought unspecified medical attention. It was reported that the patient was recovering. Additional information has been requested.

Changed on 6/14/2014

VAERS ID: 264763 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Indiana
Vaccinated:2006-09-22
Onset:2006-09-22
Submitted:2006-10-13
Entered:2006-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Lymphadenopathy, Pyrexia, Injection site swelling

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: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0609USA07045

Write-up: Information has been received from a physician concerning a 17 year old female patient who on 22-SEP-2006 was vaccinated IM with a first 0.5 ml dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). There was no concomitant medication. On 22-SEP-2006 the patient developed swollen lymph nodes in the neck and groin, swelling at injection site and low grade fever. The patient sought unspecified medical attention. It was reported that the patient was recovering. Additional information has been requested.

Changed on 3/14/2015

VAERS ID: 264763 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Indiana
Vaccinated:2006-09-22
Onset:2006-09-22
Submitted:2006-10-13
Entered:2006-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Lymphadenopathy, Pyrexia, Injection site swelling

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: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0609USA07045

Write-up: Information has been received from a physician concerning a 17 year old female patient who on 22-SEP-2006 was vaccinated IM with a first 0.5 ml dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). There was no concomitant medication. On 22-SEP-2006 the patient developed swollen lymph nodes in the neck and groin, swelling at injection site and low grade fever. The patient sought unspecified medical attention. It was reported that the patient was recovering. Additional information has been requested.

Changed on 9/14/2017

VAERS ID: 264763 Before After
VAERS Form:(blank) 1
Age:17.0
Gender:Female
Location:Indiana
Vaccinated:2006-09-22
Onset:2006-09-22
Submitted:2006-10-13
Entered:2006-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Lymphadenopathy, Pyrexia, Injection site swelling

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: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0609USA07045

Write-up: Information has been received from a physician concerning a 17 year old female patient who on 22-SEP-2006 was vaccinated IM with a first 0.5 ml dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). There was no concomitant medication. On 22-SEP-2006 the patient developed swollen lymph nodes in the neck and groin, swelling at injection site and low grade fever. The patient sought unspecified medical attention. It was reported that the patient was recovering. Additional information has been requested.

Changed on 2/14/2018

VAERS ID: 264763 Before After
VAERS Form:1
Age:17.0
Gender:Female
Location:Indiana
Vaccinated:2006-09-22
Onset:2006-09-22
Submitted:2006-10-13
Entered:2006-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Lymphadenopathy, Pyrexia, Injection site swelling

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: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0609USA07045

Write-up: Information has been received from a physician concerning a 17 year old female patient who on 22-SEP-2006 was vaccinated IM with a first 0.5 ml dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). There was no concomitant medication. On 22-SEP-2006 the patient developed swollen lymph nodes in the neck and groin, swelling at injection site and low grade fever. The patient sought unspecified medical attention. It was reported that the patient was recovering. Additional information has been requested.

Changed on 6/14/2018

VAERS ID: 264763 Before After
VAERS Form:1
Age:17.0
Gender:Female
Location:Indiana
Vaccinated:2006-09-22
Onset:2006-09-22
Submitted:2006-10-13
Entered:2006-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Lymphadenopathy, Pyrexia, Injection site swelling

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: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0609USA07045

Write-up: Information has been received from a physician concerning a 17 year old female patient who on 22-SEP-2006 was vaccinated IM with a first 0.5 ml dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). There was no concomitant medication. On 22-SEP-2006 the patient developed swollen lymph nodes in the neck and groin, swelling at injection site and low grade fever. The patient sought unspecified medical attention. It was reported that the patient was recovering. Additional information has been requested.

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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=264763&WAYBACKHISTORY=ON


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