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This is VAERS ID 267454

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

267454
VAERS Form:
Age:
Gender:Female
Location:Iowa
Vaccinated:2006-09-22
Onset:2006-09-23
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTOX: DIPHTHERIA TOXOIDS (UNKNOWN MFR) / UNKNOWN MANUFACTURER - / - - / -
HEP: HEP B (UNKNOWN MFR) / UNKNOWN MANUFACTURER - / - - / -
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 653650/0702F / - - / -

Administered by: Other      Purchased by: Unknown
Symptoms: Pruritus

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: Unknown
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Information has been received from a physician concerning a female in her 20''''s with intermittent problems with asthma and no known drug allergies, who on 22-SEPT-2006 was vaccinated into the left deltoid with a dose of HPV rL1 6 11 16 18 VLP vaccine (yea"st). (Lot #653650/0702F). Concomitant therapy given that day included a dose of diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid and a dose of hepatitis A virus vaccine inactivated (+) hepatitis B virus vaccine rHBsAg (y


Changed on 12/8/2009

267454 Before After
VAERS Form:
Age:
Gender:Female
Location:Iowa
Vaccinated:2006-09-22
Onset:2006-09-23
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTOX: DIPHTHERIA TOXOIDS (UNKNOWN MFR) DIPHTHERIA TOXOIDS (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
HEP: HEP B (UNKNOWN MFR) HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. 653650/0702F / - - / -

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

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: Unknown
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) WAES0610USA12643

Write-up:Information has been received from a physician concerning a female in her 20''''s 20''s with intermittent problems with asthma and no known drug allergies, who on 22-SEPT-2006 was vaccinated into the left deltoid with a dose of HPV rL1 6 11 16 18 VLP vaccine (yea"st). (yeast). (Lot #653650/0702F). Concomitant therapy given that day included a dose of diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid and a dose of hepatitis A virus vaccine inactivated (+) hepatitis B virus vaccine rHBsAg (y (yeast) (Twinrix). It was noted that the vaccines were administered at different anatomical sites. Within 24 hours, the patient experienced intense itching all over her body. Unspecified medical attention was sought. The patient self medicated with diphenhydramine hydrochloride(Benadryl). No diagnostic laboratory tests were performed. One week later, the patient fully recovered. No product quality complaint was involved. Additional information has been requested.


Changed on 2/5/2010

267454 Before After
VAERS Form:
Age:(blank) 21.0
Gender:Female
Location:Iowa
Vaccinated:2006-09-22
Onset:2006-09-23 2006-09-27
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTOX: DIPHTHERIA TOXOIDS (NO BRAND NAME) / UNKNOWN MANUFACTURER - C2481AA / - 0 - LA / - IM
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - - / -
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB0583A / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 653650/0702F 0702F / - 0 - LA / - IM
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Pruritus

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: Unknown Asthma
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type': WAES0610USA12643

Write-up:Information has been received from a physician concerning a female in her 20''s with intermittent problems with asthma and no known drug allergies, who on 22-SEPT-2006 at 13:00 was vaccinated IM into the left deltoid with a first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). GARDASIL (Lot #653650/0702F). Concomitant therapy given that day included a first dose of diphtheria toxoid (+) pertussis acellular vaccine DTaP (unspecified) (+) tetanus toxoid given IM into the left arm, a first dose of TWINRIX (lot# AHABB0583A) given IM into the right arm and a first dose of hepatitis A virus vaccine inactivated (+) hepatitis B virus vaccine rHBsAg (yeast) (Twinrix). typhoid vaccine. On 27-SEP-2006, the patient experienced intense itching all oer her body. The patient self medicated with BENADRYL. The itching was mostly on theinside of her legs and her back. She was treated with ZYRTEC. No diagnostic laboratory tests were pereformed. Subsequently, the patient fully recovered. No product qualitycomplaint was involved. It was noted that the vaccines were administered at different anatomical sites. Within 24 hours, the patient experienced intense itching all over her body. Unspecified medical attention was sought. The patient self medicated with diphenhydramine hydrochloride(Benadryl). No diagnostic laboratory tests were performed. One week later, the patient fully recovered. No product quality complaint was involved. Additional information has been requested.


Changed on 7/31/2010

267454 Before After
VAERS Form:
Age:21.0
Gender:Female
Location:Iowa
Vaccinated:2006-09-22
Onset:2006-09-27
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTOX: DIPHTHERIA TOXOIDS (NO BRAND NAME) / UNKNOWN MANUFACTURER C2481AA / 0 LA / IM
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB0583A / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0702F / 0 LA / IM
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Pruritus generalised

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: Asthma
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type': WAES0610USA12643

Write-up:Information has been received from a physician concerning a female in her 20''s with intermittent problems with asthma and no known drug allergies, who on 22-SEPT-2006 at 13:00 was vaccinated IM into the left deltoid with a first dose of GARDASIL (Lot #653650/0702F). Concomitant therapy given that day included a first dose of DTaP (unspecified) given IM into the left arm, a first dose of TWINRIX (lot# AHABB0583A) given IM into the right arm and a first dose of typhoid vaccine. On 27-SEP-2006, the patient experienced intense itching all oer her body. The patient self medicated with BENADRYL. The itching was mostly on theinside of her legs and her back. She was treated with ZYRTEC. No diagnostic laboratory tests were pereformed. Subsequently, the patient fully recovered. No product qualitycomplaint was involved. It was noted that the vaccines were administered at different anatomical sites. Unspecified medical attention was sought. No diagnostic laboratory tests were performed. Additional information has been requested.


Changed on 3/14/2014

267454 Before After
VAERS Form:
Age:21.0 20.0
Gender:Female
Location:Iowa
Vaccinated:2006-09-22
Onset:2006-09-27
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTOX: DIPHTHERIA TOXOIDS (NO BRAND NAME) / UNKNOWN MANUFACTURER C2481AA C2491AA / 0 LA / IM
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB0583A / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0702F / 0 LA / IM
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Pruritus generalised

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: Asthma
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type': WAES0610USA12643

Write-up:Information has been received from a physician concerning a female in her 20''s with intermittent problems with asthma and no known drug allergies, who on 22-SEPT-2006 at 13:00 was vaccinated IM into the left deltoid with a first dose of GARDASIL (Lot #653650/0702F). Concomitant therapy given that day included a first dose of DTaP (unspecified) given IM into the left arm, a first dose of TWINRIX (lot# AHABB0583A) given IM into the right arm and a first dose of typhoid vaccine. On 27-SEP-2006, the patient experienced intense itching all oer her body. The patient self medicated with BENADRYL. The itching was mostly on theinside of her legs and her back. She was treated with ZYRTEC. No diagnostic laboratory tests were pereformed. Subsequently, the patient fully recovered. No product qualitycomplaint was involved. It was noted that the vaccines were administered at different anatomical sites. Unspecified medical attention was sought. No diagnostic laboratory tests were performed. Additional information has been requested.


Changed on 9/14/2017

267454 Before After
VAERS Form:(blank) 1
Age:20.0
Gender:Female
Location:Iowa
Vaccinated:2006-09-22
Onset:2006-09-27
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTOX: DIPHTHERIA TOXOIDS (NO BRAND NAME) / UNKNOWN MANUFACTURER C2491AA / 0 1 LA / IM
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB0583A / 0 1 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0702F / 0 1 LA / IM
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Pruritus generalised

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: Asthma
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type': WAES0610USA12643

Write-up:Information has been received from a physician concerning a female in her 20''s with intermittent problems with asthma and no known drug allergies, who on 22-SEPT-2006 at 13:00 was vaccinated IM into the left deltoid with a first dose of GARDASIL (Lot #653650/0702F). Concomitant therapy given that day included a first dose of DTaP (unspecified) given IM into the left arm, a first dose of TWINRIX (lot# AHABB0583A) given IM into the right arm and a first dose of typhoid vaccine. On 27-SEP-2006, the patient experienced intense itching all oer her body. The patient self medicated with BENADRYL. The itching was mostly on theinside of her legs and her back. She was treated with ZYRTEC. No diagnostic laboratory tests were pereformed. Subsequently, the patient fully recovered. No product qualitycomplaint was involved. It was noted that the vaccines were administered at different anatomical sites. Unspecified medical attention was sought. No diagnostic laboratory tests were performed. Additional information has been requested.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=267454&WAYBACKHISTORY=ON


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