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This is VAERS ID 266639

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

266639
VAERS Form:
Age:16.0
Gender:Female
Location:Maine
Vaccinated:2006-11-08
Onset:2006-11-08
Submitted:2006-11-13
Entered:2006-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0688F / 0 RA / -
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, INC. U1808AA / 0 LA / -

Administered by: Private      Purchased by: Unknown
Symptoms: Erythema, Swelling, Tenderness

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: CONCERTA 54mg
Current Illness: NONE
Preexisting Conditions: Attention-deficit Hyperactivity disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:10.4 cm X 7.0 cm area of redness. Swelling and tenderness. Complain of burning at site left deltoid.


Changed on 12/8/2009

266639 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Maine
Vaccinated:2006-11-08
Onset:2006-11-08
Submitted:2006-11-13
Entered:2006-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. 0688F / 0 RA / -
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, INC. AVENTIS PASTEUR U1808AA / 0 LA / -

Administered by: Private      Purchased by: Unknown Other
Symptoms: Erythema, Swelling, Tenderness

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: CONCERTA 54mg
Current Illness: NONE
Preexisting Conditions: Attention-deficit Hyperactivity disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:10.4 cm X 7.0 cm area of redness. Swelling and tenderness. Complain of burning at site left deltoid.


Changed on 4/7/2010

266639 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Maine
Vaccinated:2006-11-08
Onset:2006-11-08
Submitted:2006-11-13
Entered:2006-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0688F / 0 RA / -
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U1808AA / 0 LA / -

Administered by: Private      Purchased by: Other
Symptoms: Erythema, Swelling, Tenderness

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: CONCERTA 54mg
Current Illness: NONE
Preexisting Conditions: Attention-deficit Hyperactivity disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:10.4 cm X 7.0 cm area of redness. Swelling and tenderness. Complain of burning at site left deltoid.


Changed on 5/14/2017

266639 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Maine
Vaccinated:2006-11-08
Onset:2006-11-08
Submitted:2006-11-13
Entered:2006-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0688F / 0 RA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U1808AA / 0 LA / -

Administered by: Private      Purchased by: Other
Symptoms: Erythema, Swelling, Tenderness

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: CONCERTA 54mg
Current Illness: NONE
Preexisting Conditions: Attention-deficit Hyperactivity disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:10.4 cm X 7.0 cm area of redness. Swelling and tenderness. Complain of burning at site left deltoid.


Changed on 9/14/2017

266639 Before After
VAERS Form:(blank) 1
Age:16.0
Gender:Female
Location:Maine
Vaccinated:2006-11-08
Onset:2006-11-08
Submitted:2006-11-13
Entered:2006-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0688F / 0 1 RA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1808AA / 0 1 LA / -

Administered by: Private      Purchased by: Other
Symptoms: Erythema, Swelling, Tenderness

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: CONCERTA 54mg
Current Illness: NONE
Preexisting Conditions: Attention-deficit Hyperactivity disorder
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:10.4 cm X 7.0 cm area of redness. Swelling and tenderness. Complain of burning at site left deltoid.


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