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This is VAERS ID 267424

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

267424
VAERS Form:
Age:14.0
Gender:Female
Location:California
Vaccinated:2006-10-05
Onset:2006-10-05
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (UNKNOWN MFR) / UNKNOWN MANUFACTURER - / - - / -
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. - / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Muscle spasms, Pain

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:
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up:Information has been received from a physician concerning a 14 year old female patient who on 05-OCT-2006 was vaccinated IM with a dose of HPV. Concomitant therapy included hepatitis A virus vaccine (unspecified), administered at the same time and in the"same arm. The physician reported that the patient was experiencing /"severe spasmatic pain in her arm/", and that the muscle would tense up for a 5 to 10 minute time frame. An hour later the pain would subside. Medical attention was sought. The patient re


Changed on 12/8/2009

267424 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:California
Vaccinated:2006-10-05
Onset:2006-10-05
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (UNKNOWN MFR) HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. - / - - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Muscle spasms, Pain

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:
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': (blank) WAES0610USA06133

Write-up:Information has been received from a physician concerning a 14 year old female patient who on 05-OCT-2006 was vaccinated IM with a dose of HPV. Concomitant therapy included hepatitis A virus vaccine (unspecified), administered at the same time and in the"same the same arm. The physician reported that the patient was experiencing /"severe "severe spasmatic pain in her arm/", arm", and that the muscle would tense up for a 5 to 10 minute time frame. An hour later the pain would subside. Medical attention was sought. The patient re recovered the next day, 06-OCT-2006. Additional information has been requested.


Changed on 3/14/2014

267424 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:California
Vaccinated:2006-10-05
Onset:2006-10-05
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - 0688F / - - UN / - UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - 0602F / - - UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Muscle spasms, Pain

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:
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0610USA06133

Write-up:Information has been received from a physician concerning a 14 year old female patient who on 05-OCT-2006 was vaccinated IM with a dose of HPV. Concomitant therapy included hepatitis A virus vaccine (unspecified), administered at the same time and in the same arm. The physician reported that the patient was experiencing "severe spasmatic pain in her arm", and that the muscle would tense up for a 5 to 10 minute time frame. An hour later the pain would subside. Medical attention was sought. The patient recovered the next day, 06-OCT-2006. Additional information has been requested.


Changed on 9/14/2017

267424 Before After
VAERS Form:(blank) 1
Age:14.0
Gender:Female
Location:California
Vaccinated:2006-10-05
Onset:2006-10-05
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER 0688F / - UNK UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0602F / - UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Muscle spasms, Pain

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:
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0610USA06133

Write-up:Information has been received from a physician concerning a 14 year old female patient who on 05-OCT-2006 was vaccinated IM with a dose of HPV. Concomitant therapy included hepatitis A virus vaccine (unspecified), administered at the same time and in the same arm. The physician reported that the patient was experiencing "severe spasmatic pain in her arm", and that the muscle would tense up for a 5 to 10 minute time frame. An hour later the pain would subside. Medical attention was sought. The patient recovered the next day, 06-OCT-2006. Additional information has been requested.


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