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This is VAERS ID 266371

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 266371
Age:15.0
Gender:Female
Location:California
Vaccinated:2006-10-03
Onset:2006-10-06
Submitted:2006-11-06
Entered:2006-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0702F / 0 UN / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Pruritus, Urticaria

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Ortho Tri Cyclen LO
Current Illness:
Preexisting Conditions: Hypersensitivity.
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Information has been received from a physician and the mother of a 15 year old female with a history of hypersensitivity reactions to allergens. On 10/3/06, the pt was vaccinated IM with the first dose of 0.5ml of HPV vaccine (lot 653650/0702F. Concomitan"t therapy included Ortho Tri Cyclen LO started on 10/6/06. On 10/06/06, the pt developed widespread itching and hives of both upper and lower extremities. The pt did not experience respiratory symptoms. The pt was self treated with Benadryl with only mild


Changed on 12/8/2009

VAERS ID: 266371 Before After
Age:15.0
Gender:Female
Location:California
Vaccinated:2006-10-03
Onset:2006-10-06
Submitted:2006-11-06
Entered:2006-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. 0702F / 0 UN / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Pruritus, Urticaria

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Ortho Tri Cyclen LO
Current Illness:
Preexisting Conditions: Hypersensitivity.
Diagnostic Lab Data:
CDC 'Split Type': (blank) WAES0610USA14679

Write-up:Information has been received from a physician and the mother of a 15 year old female with a history of hypersensitivity reactions to allergens. On 10/3/06, the pt was vaccinated IM with the first dose of 0.5ml of HPV vaccine (lot 653650/0702F. Concomitan"t Concomitant therapy included Ortho Tri Cyclen LO started on 10/6/06. On 10/06/06, the pt developed widespread itching and hives of both upper and lower extremities. The pt did not experience respiratory symptoms. The pt was self treated with Benadryl with only mild improvement. A nurse in the local ER was consultated by phone but the pt did not require hospitalization. The symptoms resolved after one week and the pt had not experienced further problems. On 10/13/06 the pt had recovered from the event. The physician considered the event to be serious as disabling. Additional information has been requested.


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