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This is VAERS ID 264783

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

264783
VAERS Form:
Age:11.0
Gender:Female
Location:New Jersey
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. - / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Headache, 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up:Information has been received from a physician concerning an 11 year old female patient who on an unspecified date was vaccinated IM with her first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). Within one to two days after administration, the patient de"veloped headache and fever. No medical attention was sought. Her outcome was not reported. Additional information has been requested.


Changed on 12/8/2009

264783 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:New Jersey
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. - / - - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Headache, 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': (blank) WAES0610USA01164

Write-up:Information has been received from a physician concerning an 11 year old female patient who on an unspecified date was vaccinated IM with her first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). Within one to two days after administration, the patient de"veloped developed headache and fever. No medical attention was sought. Her outcome was not reported. Additional information has been requested.


Changed on 1/5/2010

264783 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:New Jersey
Vaccinated:0000-00-00 2006-09-19
Onset:0000-00-00 2006-09-19
Submitted:2006-10-13 2007-01-05
Entered:2006-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - 0688F / - 0 - UN / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2559 / 0 UN / UN

Administered by: Other Private      Purchased by: Other Private
Symptoms: Headache, 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK None
Allergies:
Diagnostic Lab Data: UNK body temp 09/19/06 101 -
CDC 'Split Type': WAES0610USA01164

Write-up:Information has been received from a physician concerning an 11 year old female patient who on an unspecified date was vaccinated IM with her first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). Within one to two days after administration, the patient developed headache and fever. No medical attention was sought. Her outcome was not reported. Additional information has been requested. This is in follow-up to report (s) previously submitted on 10/13/2006. Information has been received from a physician concerning a 11 year old female patient who on an unspecified date was vaccinated IM with her first dose of GARDASIL. Within one to two days after administration, the patient developed headache and fever. No medical attention was sought. Her outcome was not reported. Follow up information has been received regarding the 11 year old white female with no medical history who at 2:30 p.m. on 19-SEP-2006 was vaccinated in the right arm with her first dose of GARDASIL, lot #653735/0688F. She received her first dose of ADACEL in the left arm at the same time. At 7:00 p.m. on the same day, she developed a headache. She woke up during the night with severe headache. Fever was approximately 101-102. On the afternoon of 20-SEP-2006 she was better and able to attend school. It was reported that she recovered from headache and fever on the afternoon of 20-SEP-2006. Additional information is not expected.


Changed on 2/5/2010

264783 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:New Jersey
Vaccinated:2006-09-19
Onset:2006-09-19
Submitted:2007-01-05
Entered:2006-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0688F / 0 UN / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2559 / 0 UN / UN

Administered by: Private      Purchased by: Private
Symptoms: Headache, 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: body temp 09/19/06 101 -
CDC 'Split Type': WAES0610USA01164

Write-up:Information has been received from a physician concerning an 11 year old female patient who on an unspecified date was vaccinated IM with her first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). Within one to two days after administration, the patient developed headache and fever. No medical attention was sought. Her outcome was not reported. Additional information has been requested. This is in follow-up to report (s) previously submitted on 10/13/2006. Information has been received from a physician concerning a 11 year old female patient who on an unspecified date was vaccinated IM with her first dose of GARDASIL. Within one to two days after administration, the patient developed headache and fever. No medical attention was sought. Her outcome was not reported. Follow up information has been received regarding the 11 year old white female with no medical history who at 2:30 p.m. on 19-SEP-2006 was vaccinated in the right arm with her first dose of GARDASIL, lot #653735/0688F. She received her first dose of ADACEL in the left arm at the same time. At 7:00 p.m. on the same day, she developed a headache. She woke up during the night with severe headache. Fever was approximately 101-102. On the afternoon of 20-SEP-2006 she was better and able to attend school. It was reported that she recovered from headache and fever on the afternoon of 20-SEP-2006. Additional information is not expected. This is a consolidation of two reportes concerning the same patient. WAES #0160USA00860 was previously submitted on 13-OCT-2006.


Changed on 7/31/2010

264783 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:New Jersey
Vaccinated:2006-09-19
Onset:2006-09-19
Submitted:2007-01-05
Entered:2006-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0688F / 0 UN / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2559 / 0 UN / UN

Administered by: Private      Purchased by: Private
Symptoms: Body temperature increased, Headache, 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: body temp 09/19/06 101 -
CDC 'Split Type': WAES0610USA01164

Write-up:Information has been received from a physician concerning an 11 year old female patient who on an unspecified date was vaccinated IM with her first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). Within one to two days after administration, the patient developed headache and fever. No medical attention was sought. Her outcome was not reported. Additional information has been requested. This is in follow-up to report (s) previously submitted on 10/13/2006. Information has been received from a physician concerning a 11 year old female patient who on an unspecified date was vaccinated IM with her first dose of GARDASIL. Within one to two days after administration, the patient developed headache and fever. No medical attention was sought. Her outcome was not reported. Follow up information has been received regarding the 11 year old white female with no medical history who at 2:30 p.m. on 19-SEP-2006 was vaccinated in the right arm with her first dose of GARDASIL, lot #653735/0688F. She received her first dose of ADACEL in the left arm at the same time. At 7:00 p.m. on the same day, she developed a headache. She woke up during the night with severe headache. Fever was approximately 101-102. On the afternoon of 20-SEP-2006 she was better and able to attend school. It was reported that she recovered from headache and fever on the afternoon of 20-SEP-2006. Additional information is not expected. This is a consolidation of two reportes concerning the same patient. WAES #0160USA00860 was previously submitted on 13-OCT-2006.


Changed on 6/14/2014

264783 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:New Jersey
Vaccinated:2006-09-19
Onset:2006-09-19
Submitted:2007-01-05
Entered:2006-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0688F / 0 UN / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2559 / 0 UN / UN

Administered by: Private      Purchased by: Private
Symptoms: Body temperature increased, Headache, 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: body temp 09/19/06 101 -
CDC 'Split Type': WAES0610USA01164

Write-up:Information has been received from a physician concerning an 11 year old female patient who on an unspecified date was vaccinated IM with her first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). Within one to two days after administration, the patient developed headache and fever. No medical attention was sought. Her outcome was not reported. Additional information has been requested. This is in follow-up to report (s) previously submitted on 10/13/2006. Information has been received from a physician concerning a 11 year old female patient who on an unspecified date was vaccinated IM with her first dose of GARDASIL. Within one to two days after administration, the patient developed headache and fever. No medical attention was sought. Her outcome was not reported. Follow up information has been received regarding the 11 year old white female with no medical history who at 2:30 p.m. on 19-SEP-2006 was vaccinated in the right arm with her first dose of GARDASIL, lot #653735/0688F. She received her first dose of ADACEL in the left arm at the same time. At 7:00 p.m. on the same day, she developed a headache. She woke up during the night with severe headache. Fever was approximately 101-102. On the afternoon of 20-SEP-2006 she was better and able to attend school. It was reported that she recovered from headache and fever on the afternoon of 20-SEP-2006. Additional information is not expected. This is a consolidation of two reportes concerning the same patient. WAES #0160USA00860 was previously submitted on 13-OCT-2006.


Changed on 3/14/2015

264783 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:New Jersey
Vaccinated:2006-09-19
Onset:2006-09-19
Submitted:2007-01-05
Entered:2006-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0688F / 0 UN / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2559 / 0 UN / UN

Administered by: Private      Purchased by: Private
Symptoms: Body temperature increased, Headache, 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: body temp 09/19/06 101 -
CDC 'Split Type': WAES0610USA01164

Write-up:Information has been received from a physician concerning an 11 year old female patient who on an unspecified date was vaccinated IM with her first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). Within one to two days after administration, the patient developed headache and fever. No medical attention was sought. Her outcome was not reported. Additional information has been requested. This is in follow-up to report (s) previously submitted on 10/13/2006. Information has been received from a physician concerning a 11 year old female patient who on an unspecified date was vaccinated IM with her first dose of GARDASIL. Within one to two days after administration, the patient developed headache and fever. No medical attention was sought. Her outcome was not reported. Follow up information has been received regarding the 11 year old white female with no medical history who at 2:30 p.m. on 19-SEP-2006 was vaccinated in the right arm with her first dose of GARDASIL, lot #653735/0688F. She received her first dose of ADACEL in the left arm at the same time. At 7:00 p.m. on the same day, she developed a headache. She woke up during the night with severe headache. Fever was approximately 101-102. On the afternoon of 20-SEP-2006 she was better and able to attend school. It was reported that she recovered from headache and fever on the afternoon of 20-SEP-2006. Additional information is not expected. This is a consolidation of two reportes concerning the same patient. WAES #0160USA00860 was previously submitted on 13-OCT-2006.


Changed on 9/14/2017

264783 Before After
VAERS Form:(blank) 1
Age:11.0
Gender:Female
Location:New Jersey
Vaccinated:2006-09-19
Onset:2006-09-19
Submitted:2007-01-05
Entered:2006-10-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0688F / 0 1 UN / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2559 / 0 1 UN / UN

Administered by: Private      Purchased by: Private
Symptoms: Body temperature increased, Headache, 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: body temp 09/19/06 101 -
CDC 'Split Type': WAES0610USA01164

Write-up:Information has been received from a physician concerning an 11 year old female patient who on an unspecified date was vaccinated IM with her first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). Within one to two days after administration, the patient developed headache and fever. No medical attention was sought. Her outcome was not reported. Additional information has been requested. This is in follow-up to report (s) previously submitted on 10/13/2006. Information has been received from a physician concerning a 11 year old female patient who on an unspecified date was vaccinated IM with her first dose of GARDASIL. Within one to two days after administration, the patient developed headache and fever. No medical attention was sought. Her outcome was not reported. Follow up information has been received regarding the 11 year old white female with no medical history who at 2:30 p.m. on 19-SEP-2006 was vaccinated in the right arm with her first dose of GARDASIL, lot #653735/0688F. She received her first dose of ADACEL in the left arm at the same time. At 7:00 p.m. on the same day, she developed a headache. She woke up during the night with severe headache. Fever was approximately 101-102. On the afternoon of 20-SEP-2006 she was better and able to attend school. It was reported that she recovered from headache and fever on the afternoon of 20-SEP-2006. Additional information is not expected. This is a consolidation of two reportes concerning the same patient. WAES #0160USA00860 was previously submitted on 13-OCT-2006.


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