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This is VAERS ID 267455

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 267455
Age:12.0
Gender:Female
Location:Unknown
Vaccinated:2006-09-28
Onset:2006-09-29
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 653978/0955F / 0 - / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Rash

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up:Information has been received from a registered nurse concerning a 12 year old white female with no know drug allergies, who on 28-SEP-2006 at 14:30 was vaccinated IM into the right deltoid with a first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). (Lot"#653978/0955F). On 29-SEP-2006 at 08:00 the patient experienced a /"large red rash area near the injection site, 1x1cm red around injection site and 3x2cm spot in the superior lateral site area, and red raised spot inferior and lateral to the injection si


Changed on 12/8/2009

VAERS ID: 267455 Before After
Age:12.0
Gender:Female
Location:Unknown
Vaccinated:2006-09-28
Onset:2006-09-29
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. 653978/0955F / 0 - / IM

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

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC 'Split Type': (blank) WAES0610USA12794

Write-up:Information has been received from a registered nurse concerning a 12 year old white female with no know drug allergies, who on 28-SEP-2006 at 14:30 was vaccinated IM into the right deltoid with a first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). (Lot"#653978/0955F). (Lot #653978/0955F). On 29-SEP-2006 at 08:00 the patient experienced a /"large "large red rash area near the injection site, 1x1cm red around injection site and 3x2cm spot in the superior lateral site area, and red raised spot inferior and lateral to the injection si site." No diagnostic laboratory studies were performed. The patient was treated with cool compresses, ibuprofen (Advil) or ibuprofen (Motrin) and cetirizine hydorchloride (Zyrtec) every 6 to 8 hours. The patient was told to go to the emergency room if her condition worsened. Subsequently, the patient recovered as there was no more follow up phone calls to the office. Additional information is not expected.


Changed on 2/14/2017

VAERS ID: 267455 Before After
Age:12.0
Gender:Female
Location:Unknown Federated States of Micronesia
Vaccinated:2006-09-28
Onset:2006-09-29
Submitted:2006-11-14
Entered:2006-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 653978/0955F / 0 - / IM

Administered by: Private      Purchased by: Private
Symptoms: Rash

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC 'Split Type': WAES0610USA12794

Write-up:Information has been received from a registered nurse concerning a 12 year old white female with no know drug allergies, who on 28-SEP-2006 at 14:30 was vaccinated IM into the right deltoid with a first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast). (Lot #653978/0955F). On 29-SEP-2006 at 08:00 the patient experienced a "large red rash area near the injection site, 1x1cm red around injection site and 3x2cm spot in the superior lateral site area, and red raised spot inferior and lateral to the injection site." No diagnostic laboratory studies were performed. The patient was treated with cool compresses, ibuprofen (Advil) or ibuprofen (Motrin) and cetirizine hydorchloride (Zyrtec) every 6 to 8 hours. The patient was told to go to the emergency room if her condition worsened. Subsequently, the patient recovered as there was no more follow up phone calls to the office. Additional information is not expected.


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