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This is VAERS ID 267442

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

267442
VAERS Form:
Age:17.0
Gender:Female
Location:New York
Vaccinated:2006-10-10
Onset:2006-10-11
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0800F / 0 - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Rash, Urticaria

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: (therapy unspecified), CLARINEX
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up:Initial and follow up information has been received from a physician concerning a 17 year old white female student with no pre-existing medical conditions. On 10-Oct2006, at 4 PM, the patient was vaccinated intramuscularly with the first dose of HPV rL1 6"11 16 18 VLP vaccine (yeast) (Lot#654540/0800F). Concomitant therapy included an unspecified therapy (reported as /"over-the-counter acne medication''''). There were no illnesses noted at the time of vaccination. The physician reported that when the patien


Changed on 12/8/2009

267442 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:New York
Vaccinated:2006-10-10
Onset:2006-10-11
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. 0800F / 0 - / IM

Administered by: Private      Purchased by: Unknown Other
Symptoms: Rash, Urticaria

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: (therapy unspecified), CLARINEX
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': (blank) WAES0610USA11390

Write-up:Initial and follow up information has been received from a physician concerning a 17 year old white female student with no pre-existing medical conditions. On 10-Oct2006, at 4 PM, the patient was vaccinated intramuscularly with the first dose of HPV rL1 6"11 6 11 16 18 VLP vaccine (yeast) (Lot#654540/0800F). Concomitant therapy included an unspecified therapy (reported as /"over-the-counter "over-the-counter acne medication''''). medication''). There were no illnesses noted at the time of vaccination. The physician reported that when the patien patient left the office she was fine. That same day, the patient had been given desloratadine (CLARINEX) without positive result, by her mother and without physician consultation. On 11-Oct-2006, at 4 PM, the patient developed a rash which appeared on the ear tips, face, elbows, knee caps and around the belly button area. On 14-Oct-2006, the patient went to the emergency room (ER) but was not admitted for an overnight stay. The patient was treated with prednisone. The physician reported that she did not see the patient. The physician reported that the patient "had hives" and was given the steroids in the emergency room which she considered to be routine. At the time of this report, the patient had not recovered from the event. The physician considered the event to be non-serious. Additional information is expected.


Changed on 9/14/2017

267442 Before After
VAERS Form:(blank) 1
Age:17.0
Gender:Female
Location:New York
Vaccinated:2006-10-10
Onset:2006-10-11
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0800F / 0 1 - / IM

Administered by: Private      Purchased by: Other
Symptoms: Rash, Urticaria

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: (therapy unspecified), CLARINEX
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0610USA11390

Write-up:Initial and follow up information has been received from a physician concerning a 17 year old white female student with no pre-existing medical conditions. On 10-Oct2006, at 4 PM, the patient was vaccinated intramuscularly with the first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast) (Lot#654540/0800F). Concomitant therapy included an unspecified therapy (reported as "over-the-counter acne medication''). There were no illnesses noted at the time of vaccination. The physician reported that when the patient left the office she was fine. That same day, the patient had been given desloratadine (CLARINEX) without positive result, by her mother and without physician consultation. On 11-Oct-2006, at 4 PM, the patient developed a rash which appeared on the ear tips, face, elbows, knee caps and around the belly button area. On 14-Oct-2006, the patient went to the emergency room (ER) but was not admitted for an overnight stay. The patient was treated with prednisone. The physician reported that she did not see the patient. The physician reported that the patient "had hives" and was given the steroids in the emergency room which she considered to be routine. At the time of this report, the patient had not recovered from the event. The physician considered the event to be non-serious. Additional information is expected.


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