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This is VAERS ID 267428

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

267428
VAERS Form:
Age:21.0
Gender:Female
Location:Delaware
Vaccinated:2006-09-21
Onset:2006-09-21
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. - / - - / -

Administered by: Other      Purchased by: Unknown
Symptoms: Urticaria

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: UNK
Current Illness: Penicillin allergy; Sulfonamide allergy
Preexisting Conditions: Hypersensitivity reaction
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up:Information has been received from a nurse concerning a 21 year old female with a history of an allergic reaction to penicillin and sulfonamide who on 21-SEP-2006 was vaccinated with HPV. On 21-SEP-2006, following vaccination, the patient broke out in hiv"es all over her upper body particularly in the face, chest, and arms. Unspecified medical attention was sought. Subsequently, the patient recovered on 26- SEP-2006. Additional information has been requested.


Changed on 12/8/2009

267428 Before After
VAERS Form:
Age:21.0
Gender:Female
Location:Delaware
Vaccinated:2006-09-21
Onset:2006-09-21
Submitted:2006-11-14
Entered:2006-11-16
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: Urticaria

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: UNK
Current Illness: Penicillin allergy; Sulfonamide allergy
Preexisting Conditions: Hypersensitivity reaction
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': (blank) WAES0610USA08303

Write-up:Information has been received from a nurse concerning a 21 year old female with a history of an allergic reaction to penicillin and sulfonamide who on 21-SEP-2006 was vaccinated with HPV. On 21-SEP-2006, following vaccination, the patient broke out in hiv"es hives all over her upper body particularly in the face, chest, and arms. Unspecified medical attention was sought. Subsequently, the patient recovered on 26- SEP-2006. Additional information has been requested.


Changed on 3/14/2014

267428 Before After
VAERS Form:
Age:21.0
Gender:Female
Location:Delaware
Vaccinated:2006-09-21
Onset:2006-09-21
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - - UN / - UN

Administered by: Other      Purchased by: Other
Symptoms: Urticaria

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: UNK
Current Illness: Penicillin allergy; Sulfonamide allergy
Preexisting Conditions: Hypersensitivity reaction
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0610USA08303

Write-up:Information has been received from a nurse concerning a 21 year old female with a history of an allergic reaction to penicillin and sulfonamide who on 21-SEP-2006 was vaccinated with HPV. On 21-SEP-2006, following vaccination, the patient broke out in hives all over her upper body particularly in the face, chest, and arms. Unspecified medical attention was sought. Subsequently, the patient recovered on 26- SEP-2006. Additional information has been requested.


Changed on 6/14/2014

267428 Before After
VAERS Form:
Age:21.0
Gender:Female
Location:Delaware
Vaccinated:2006-09-21
Onset:2006-09-21
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Urticaria

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: UNK
Current Illness: Penicillin allergy; Sulfonamide allergy
Preexisting Conditions: Hypersensitivity reaction
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0610USA08303

Write-up:Information has been received from a nurse concerning a 21 year old female with a history of an allergic reaction to penicillin and sulfonamide who on 21-SEP-2006 was vaccinated with HPV. On 21-SEP-2006, following vaccination, the patient broke out in hives all over her upper body particularly in the face, chest, and arms. Unspecified medical attention was sought. Subsequently, the patient recovered on 26- SEP-2006. Additional information has been requested.


Changed on 3/14/2015

267428 Before After
VAERS Form:
Age:21.0
Gender:Female
Location:Delaware
Vaccinated:2006-09-21
Onset:2006-09-21
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Urticaria

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: UNK
Current Illness: Penicillin allergy; Sulfonamide allergy
Preexisting Conditions: Hypersensitivity reaction
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0610USA08303

Write-up:Information has been received from a nurse concerning a 21 year old female with a history of an allergic reaction to penicillin and sulfonamide who on 21-SEP-2006 was vaccinated with HPV. On 21-SEP-2006, following vaccination, the patient broke out in hives all over her upper body particularly in the face, chest, and arms. Unspecified medical attention was sought. Subsequently, the patient recovered on 26- SEP-2006. Additional information has been requested.


Changed on 9/14/2017

267428 Before After
VAERS Form:(blank) 1
Age:21.0
Gender:Female
Location:Delaware
Vaccinated:2006-09-21
Onset:2006-09-21
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Urticaria

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: UNK
Current Illness: Penicillin allergy; Sulfonamide allergy
Preexisting Conditions: Hypersensitivity reaction
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0610USA08303

Write-up:Information has been received from a nurse concerning a 21 year old female with a history of an allergic reaction to penicillin and sulfonamide who on 21-SEP-2006 was vaccinated with HPV. On 21-SEP-2006, following vaccination, the patient broke out in hives all over her upper body particularly in the face, chest, and arms. Unspecified medical attention was sought. Subsequently, the patient recovered on 26- SEP-2006. Additional information has been requested.


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