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This is VAERS ID 264787

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

264787
VAERS Form:
Age:13.0
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. - / - - / -

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 a 13 year old female patient who on an unspecified date was vaccinated with a dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). Subsequently, the patient developed headache and fever. Her outcome was"not reported. Additional information has been requested.


Changed on 12/8/2009

264787 Before After
VAERS Form:
Age:13.0
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. - / - - / -

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) WAES0610USA03614

Write-up:Information has been received from a physician concerning a 13 year old female patient who on an unspecified date was vaccinated with a dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). Subsequently, the patient developed headache and fever. Her outcome was"not was not reported. Additional information has been requested.


Changed on 2/5/2010

264787 Before After
VAERS Form:
Age:13.0
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: HPV (GARDASIL) / MERCK & CO. INC. - / - - / -

Administered by: Other      Purchased by: 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': WAES0610USA03614

Write-up:Information has been received from a physician concerning a 13 year old female patient who on an unspecified date was vaccinated with a dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). Subsequently, the patient developed headache and fever. Her outcome was not reported. Additional information has been requested. This is a consolidation of two reports concenring the same patient. WAES# 0610USA01349 was previously submitted on 13-Oct-2006.


Changed on 2/13/2013

264787 Before After
VAERS Form:
Age:13.0
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: HPV (GARDASIL) / MERCK & CO. INC. - / - - UN / - UN

Administered by: Other      Purchased by: 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': WAES0610USA03614

Write-up:Information has been received from a physician concerning a 13 year old female patient who on an unspecified date was vaccinated with a dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). GARDASIL. Subsequently, the patient developed headache and fever. Her outcome was not reported. Additional information has been requested. This is a consolidation of two reports concenring concerning the same patient. WAES# 0610USA01349 was previously submitted on 13-Oct-2006.


Changed on 6/14/2014

264787 Before After
VAERS Form:
Age:13.0
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: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / UN

Administered by: Other      Purchased by: 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': WAES0610USA03614

Write-up:Information has been received from a physician concerning a 13 year old female patient who on an unspecified date was vaccinated with a dose of GARDASIL. Subsequently, the patient developed headache and fever. Her outcome was not reported. Additional information has been requested. This is a consolidation of two reports concerning the same patient. WAES# 0610USA01349 was previously submitted on 13-Oct-2006.


Changed on 3/14/2015

264787 Before After
VAERS Form:
Age:13.0
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: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / UN

Administered by: Other      Purchased by: 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': WAES0610USA03614

Write-up:Information has been received from a physician concerning a 13 year old female patient who on an unspecified date was vaccinated with a dose of GARDASIL. Subsequently, the patient developed headache and fever. Her outcome was not reported. Additional information has been requested. This is a consolidation of two reports concerning the same patient. WAES# 0610USA01349 was previously submitted on 13-Oct-2006.


Changed on 9/14/2017

264787 Before After
VAERS Form:(blank) 1
Age:13.0
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: HPV (GARDASIL) / MERCK & CO. INC. - / - UNK UN / UN

Administered by: Other      Purchased by: 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': WAES0610USA03614

Write-up:Information has been received from a physician concerning a 13 year old female patient who on an unspecified date was vaccinated with a dose of GARDASIL. Subsequently, the patient developed headache and fever. Her outcome was not reported. Additional information has been requested. This is a consolidation of two reports concerning the same patient. WAES# 0610USA01349 was previously submitted on 13-Oct-2006.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=264787&WAYBACKHISTORY=ON


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