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This is VAERS ID 264992

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

264992
VAERS Form:
Age:15.0
Gender:Female
Location:California
Vaccinated:2006-10-16
Onset:2006-10-18
Submitted:2006-10-19
Entered:2006-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0637F / - RA / -
TDAP: TDAP (ADACEL) / AVENTIS PASTEUR, INC. C2572AA / - LA / -

Administered by: Private      Purchased by: Unknown
Symptoms: Blister, Face oedema

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

Write-up:Received Tdap and HPV vaccine on 10/16/2006 noticed some blisters at the corner of mouth and swelling of lower lip on the evening of 10/18/2006 and facial swelling around eyes on 10/19/06. No fever, headache, dizziness or any GI symptoms.


Changed on 12/8/2009

264992 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:California
Vaccinated:2006-10-16
Onset:2006-10-18
Submitted:2006-10-19
Entered:2006-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. 0637F / - RA / -
TDAP: TDAP (ADACEL) / AVENTIS PASTEUR, INC. AVENTIS PASTEUR C2572AA / - LA / -

Administered by: Private      Purchased by: Unknown
Symptoms: Blister, Face oedema

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

Write-up:Received Tdap and HPV vaccine on 10/16/2006 noticed some blisters at the corner of mouth and swelling of lower lip on the evening of 10/18/2006 and facial swelling around eyes on 10/19/06. No fever, headache, dizziness or any GI symptoms.


Changed on 1/5/2010

264992 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:California
Vaccinated:2006-10-16
Onset:2006-10-18
Submitted:2006-10-19
Entered:2006-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / - RA / -
TDAP: TDAP (ADACEL) / AVENTIS PASTEUR SANOFI PASTEUR C2572AA / - LA / -

Administered by: Private      Purchased by: Unknown
Symptoms: Blister, Face oedema

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

Write-up:Received Tdap and HPV vaccine on 10/16/2006 noticed some blisters at the corner of mouth and swelling of lower lip on the evening of 10/18/2006 and facial swelling around eyes on 10/19/06. No fever, headache, dizziness or any GI symptoms.


Changed on 3/2/2010

264992 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:California
Vaccinated:2006-10-16
Onset:2006-10-18
Submitted:2006-10-19
Entered:2006-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / - RA / -
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2572AA / - LA / -

Administered by: Private      Purchased by: Unknown
Symptoms: Blister, Face oedema

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 Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: eosinophil count, 11/16/06, 11%; serum herpes simplex, 11/02.06, 5.6; HSV type1 and/or 2, 10/19/06, 11%; Herpes simplex virus, 10/19/06, negat.
CDC 'Split Type':

Write-up:Received Tdap and HPV vaccine on 10/16/2006 noticed some blisters at the corner of mouth and swelling of lower lip on the evening of 10/18/2006 and facial swelling around eyes on 10/19/06. No fever, headache, dizziness or any GI symptoms. Information has been received from nurse manager in a physician''s office concerning a 15 year old female who on 16-OCT-2006 at 1600 was vaccinated in the right deltoid with the first dose of GARDASIL (lot # 653937/0637P). Concomitant therapy that day included DTP. Subsequently, the patient experienced an allergic reaction, her face and body began to swell. The physician recommended the patient take an unspecified dose of BENADRYL. After raking BENADRYL the patient''s face and body swelling "went down". On 20-OCT-2006 it was reported that "the swelling became worse again". At the time of this report the patient had not recovered from the event. Follow up information was received from the patient''s physician which stated that on 18-OCT-2006 the patient developed blisters in the corners of her mouth and swelling of her lip and face and she was seen in the office. She was treated with acyclovir for possible herpes simplex. Laboratory results from 19-OCT-2006 included HSV type 1 and/or 2 was 11% and Herpes simplex virus culture was negative. On approximately 23-OCT-2006 the patient was considered to have recovered from these events. On 02-NOV-2006 the patient reported swelling on her face and lower lip again. Laboratory results that same day included serum herpes simplex type 1 IgG Ab 5.6 and a eosinophil count of 11%. The physician reported that the patient recovered from these events on an unspecified date. This report was identified from a line listing obtained on request by the Company. A 15 year old female with no pre-existing conditions was vaccinated in 16-OCT-2006, intramuscularly into the right arm with GARDASIL (lot#653937/0637F). Concomitant therapy that day included DTAP (Lot # C2572AA), vaccinated into the left arm (route unknown). The patient noticed on the evening of 1


Changed on 4/7/2010

264992 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:California
Vaccinated:2006-10-16
Onset:2006-10-18
Submitted:2006-10-19
Entered:2006-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / - RA / -
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2572AA / - LA / -

Administered by: Private      Purchased by: Unknown
Symptoms: Blister, Eosinophil count increased, Herpes simplex, Lip swelling, Swelling face, Herpes simplex serology negative

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:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: eosinophil count, 11/16/06, 11%; serum herpes simplex, 11/02.06, 5.6; HSV type1 and/or 2, 10/19/06, 11%; Herpes simplex virus, 10/19/06, negat.
CDC 'Split Type':

Write-up:Received Tdap and HPV vaccine on 10/16/2006 noticed some blisters at the corner of mouth and swelling of lower lip on the evening of 10/18/2006 and facial swelling around eyes on 10/19/06. No fever, headache, dizziness or any GI symptoms. Information has been received from nurse manager in a physician''s office concerning a 15 year old female who on 16-OCT-2006 at 1600 was vaccinated in the right deltoid with the first dose of GARDASIL (lot # 653937/0637P). Concomitant therapy that day included DTP. Subsequently, the patient experienced an allergic reaction, her face and body began to swell. The physician recommended the patient take an unspecified dose of BENADRYL. After raking BENADRYL the patient''s face and body swelling "went down". On 20-OCT-2006 it was reported that "the swelling became worse again". At the time of this report the patient had not recovered from the event. Follow up information was received from the patient''s physician which stated that on 18-OCT-2006 the patient developed blisters in the corners of her mouth and swelling of her lip and face and she was seen in the office. She was treated with acyclovir for possible herpes simplex. Laboratory results from 19-OCT-2006 included HSV type 1 and/or 2 was 11% and Herpes simplex virus culture was negative. On approximately 23-OCT-2006 the patient was considered to have recovered from these events. On 02-NOV-2006 the patient reported swelling on her face and lower lip again. Laboratory results that same day included serum herpes simplex type 1 IgG Ab 5.6 and a eosinophil count of 11%. The physician reported that the patient recovered from these events on an unspecified date. This report was identified from a line listing obtained on request by the Company. A 15 year old female with no pre-existing conditions was vaccinated in 16-OCT-2006, intramuscularly into the right arm with GARDASIL (lot#653937/0637F). Concomitant therapy that day included DTAP (Lot # C2572AA), vaccinated into the left arm (route unknown). The patient noticed on the evening of 1


Changed on 8/31/2010

264992 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:California
Vaccinated:2006-10-16
Onset:2006-10-18
Submitted:2006-10-19
Entered:2006-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / - RA / -
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2572AA / - LA / -

Administered by: Private      Purchased by: Unknown
Symptoms: Blister, Eosinophil count increased, Face oedema, Herpes simplex, Lip swelling, Swelling face, Herpes simplex serology negative

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:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: eosinophil count, 11/16/06, 11%; serum herpes simplex, 11/02.06, 5.6; HSV type1 and/or 2, 10/19/06, 11%; Herpes simplex virus, 10/19/06, negat.
CDC 'Split Type':

Write-up:Received Tdap and HPV vaccine on 10/16/2006 noticed some blisters at the corner of mouth and swelling of lower lip on the evening of 10/18/2006 and facial swelling around eyes on 10/19/06. No fever, headache, dizziness or any GI symptoms. Information has been received from nurse manager in a physician''s office concerning a 15 year old female who on 16-OCT-2006 at 1600 was vaccinated in the right deltoid with the first dose of GARDASIL (lot # 653937/0637P). Concomitant therapy that day included DTP. Subsequently, the patient experienced an allergic reaction, her face and body began to swell. The physician recommended the patient take an unspecified dose of BENADRYL. After raking BENADRYL the patient''s face and body swelling "went down". On 20-OCT-2006 it was reported that "the swelling became worse again". At the time of this report the patient had not recovered from the event. Follow up information was received from the patient''s physician which stated that on 18-OCT-2006 the patient developed blisters in the corners of her mouth and swelling of her lip and face and she was seen in the office. She was treated with acyclovir for possible herpes simplex. Laboratory results from 19-OCT-2006 included HSV type 1 and/or 2 was 11% and Herpes simplex virus culture was negative. On approximately 23-OCT-2006 the patient was considered to have recovered from these events. On 02-NOV-2006 the patient reported swelling on her face and lower lip again. Laboratory results that same day included serum herpes simplex type 1 IgG Ab 5.6 and a eosinophil count of 11%. The physician reported that the patient recovered from these events on an unspecified date. This report was identified from a line listing obtained on request by the Company. A 15 year old female with no pre-existing conditions was vaccinated in 16-OCT-2006, intramuscularly into the right arm with GARDASIL (lot#653937/0637F). Concomitant therapy that day included DTAP (Lot # C2572AA), vaccinated into the left arm (route unknown). The patient noticed on the evening of 1


Changed on 1/4/2011

264992 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:California
Vaccinated:2006-10-16
Onset:2006-10-18
Submitted:2006-10-19
Entered:2006-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / - RA / -
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2572AA / - LA / -

Administered by: Private      Purchased by: Unknown
Symptoms: Blister, Eosinophil count increased, Face oedema, Herpes simplex, Lip swelling, Swelling face, Herpes simplex serology negative

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:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: eosinophil count, 11/16/06, 11%; serum herpes simplex, 11/02.06, 5.6; HSV type1 and/or 2, 10/19/06, 11%; Herpes simplex virus, 10/19/06, negat.
CDC 'Split Type':

Write-up:Received Tdap and HPV vaccine on 10/16/2006 noticed some blisters at the corner of mouth and swelling of lower lip on the evening of 10/18/2006 and facial swelling around eyes on 10/19/06. No fever, headache, dizziness or any GI symptoms. Information has been received from nurse manager in a physician''s office concerning a 15 year old female who on 16-OCT-2006 at 1600 was vaccinated in the right deltoid with the first dose of GARDASIL (lot # 653937/0637P). Concomitant therapy that day included DTP. Subsequently, the patient experienced an allergic reaction, her face and body began to swell. The physician recommended the patient take an unspecified dose of BENADRYL. After raking BENADRYL the patient''s face and body swelling "went down". On 20-OCT-2006 it was reported that "the swelling became worse again". At the time of this report the patient had not recovered from the event. Follow up information was received from the patient''s physician which stated that on 18-OCT-2006 the patient developed blisters in the corners of her mouth and swelling of her lip and face and she was seen in the office. She was treated with acyclovir for possible herpes simplex. Laboratory results from 19-OCT-2006 included HSV type 1 and/or 2 was 11% and Herpes simplex virus culture was negative. On approximately 23-OCT-2006 the patient was considered to have recovered from these events. On 02-NOV-2006 the patient reported swelling on her face and lower lip again. Laboratory results that same day included serum herpes simplex type 1 IgG Ab 5.6 and a eosinophil count of 11%. The physician reported that the patient recovered from these events on an unspecified date. This report was identified from a line listing obtained on request by the Company. A 15 year old female with no pre-existing conditions was vaccinated in 16-OCT-2006, intramuscularly into the right arm with GARDASIL (lot#653937/0637F). Concomitant therapy that day included DTAP (Lot # C2572AA), vaccinated into the left arm (route unknown). The patient noticed on the evening of 1 18-OCT-2006, some blisters at the corner of her mouth and swelling of lower lip and facial swelling around her eyes ib 19-OCT-2006. There was no reported fever, headche, dizziness or any gastrointestinal symptoms. Additional information has been requested.


Changed on 9/14/2017

264992 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:California
Vaccinated:2006-10-16
Onset:2006-10-18
Submitted:2006-10-19
Entered:2006-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / - UNK RA / -
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2572AA / - UNK LA / -

Administered by: Private      Purchased by: Unknown
Symptoms: Blister, Eosinophil count increased, Herpes simplex, Lip swelling, Swelling face, Herpes simplex serology negative

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:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: eosinophil count, 11/16/06, 11%; serum herpes simplex, 11/02.06, 5.6; HSV type1 and/or 2, 10/19/06, 11%; Herpes simplex virus, 10/19/06, negat.
CDC 'Split Type':

Write-up:Received Tdap and HPV vaccine on 10/16/2006 noticed some blisters at the corner of mouth and swelling of lower lip on the evening of 10/18/2006 and facial swelling around eyes on 10/19/06. No fever, headache, dizziness or any GI symptoms. Information has been received from nurse manager in a physician''s office concerning a 15 year old female who on 16-OCT-2006 at 1600 was vaccinated in the right deltoid with the first dose of GARDASIL (lot # 653937/0637P). Concomitant therapy that day included DTP. Subsequently, the patient experienced an allergic reaction, her face and body began to swell. The physician recommended the patient take an unspecified dose of BENADRYL. After raking BENADRYL the patient''s face and body swelling "went down". On 20-OCT-2006 it was reported that "the swelling became worse again". At the time of this report the patient had not recovered from the event. Follow up information was received from the patient''s physician which stated that on 18-OCT-2006 the patient developed blisters in the corners of her mouth and swelling of her lip and face and she was seen in the office. She was treated with acyclovir for possible herpes simplex. Laboratory results from 19-OCT-2006 included HSV type 1 and/or 2 was 11% and Herpes simplex virus culture was negative. On approximately 23-OCT-2006 the patient was considered to have recovered from these events. On 02-NOV-2006 the patient reported swelling on her face and lower lip again. Laboratory results that same day included serum herpes simplex type 1 IgG Ab 5.6 and a eosinophil count of 11%. The physician reported that the patient recovered from these events on an unspecified date. This report was identified from a line listing obtained on request by the Company. A 15 year old female with no pre-existing conditions was vaccinated in 16-OCT-2006, intramuscularly into the right arm with GARDASIL (lot#653937/0637F). Concomitant therapy that day included DTAP (Lot # C2572AA), vaccinated into the left arm (route unknown). The patient noticed on the evening of 18-OCT-2006, some blisters at the corner of her mouth and swelling of lower lip and facial swelling around her eyes ib 19-OCT-2006. There was no reported fever, headche, dizziness or any gastrointestinal symptoms. Additional information has been requested.


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