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This is VAERS ID 267822

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

267822
VAERS Form:
Age:15.0
Gender:Female
Location:Illinois
Vaccinated:2006-11-14
Onset:2006-11-15
Submitted:2006-11-17
Entered:2006-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0954F / 1 RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Erythema, Malaise, Pruritus, Swelling face, Throat tightness

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: Benzaclin, Minocin, Orthotricyclen, Prozac
Current Illness: NONE
Preexisting Conditions: Acne, Anxiety, depression, TSS (11/05)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Pt suddenly did not feel well at 9:30 am 11/15 went to bathroom, noticed face very red, followed by intense itching - presented to clinic 1 hr after sxs started, developed swollen lips, edema around eyes and throat constriction. Epi 0.05 ml SQ immediately". 3 min later, pt improved.


Changed on 12/8/2009

267822 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Illinois
Vaccinated:2006-11-14
Onset:2006-11-15
Submitted:2006-11-17
Entered:2006-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. 0954F / 1 RA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Erythema, Malaise, Pruritus, Swelling face, Throat tightness

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: Benzaclin, Minocin, Orthotricyclen, Prozac
Current Illness: NONE
Preexisting Conditions: Acne, Anxiety, depression, TSS (11/05)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Pt suddenly did not feel well at 9:30 am 11/15 went to bathroom, noticed face very red, followed by intense itching - presented to clinic 1 hr after sxs started, developed swollen lips, edema around eyes and throat constriction. Epi 0.05 ml SQ immediately". immediately. 3 min later, pt improved.


Changed on 5/14/2017

267822 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Illinois
Vaccinated:2006-11-14
Onset:2006-11-15
Submitted:2006-11-17
Entered:2006-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0954F / 1 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Malaise, Periorbital oedema, Pruritus, Swelling face, Throat tightness

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: Benzaclin, Minocin, Orthotricyclen, Prozac
Current Illness: NONE
Preexisting Conditions: Acne, Anxiety, depression, TSS (11/05)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Pt suddenly did not feel well at 9:30 am 11/15 went to bathroom, noticed face very red, followed by intense itching - presented to clinic 1 hr after sxs started, developed swollen lips, edema around eyes and throat constriction. Epi 0.05 ml SQ immediately. 3 min later, pt improved.


Changed on 9/14/2017

267822 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:Illinois
Vaccinated:2006-11-14
Onset:2006-11-15
Submitted:2006-11-17
Entered:2006-11-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0954F / 1 2 RA / IM

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Malaise, Periorbital oedema, Pruritus, Swelling face, Throat tightness

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: Benzaclin, Minocin, Orthotricyclen, Prozac
Current Illness: NONE
Preexisting Conditions: Acne, Anxiety, depression, TSS (11/05)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Pt suddenly did not feel well at 9:30 am 11/15 went to bathroom, noticed face very red, followed by intense itching - presented to clinic 1 hr after sxs started, developed swollen lips, edema around eyes and throat constriction. Epi 0.05 ml SQ immediately. 3 min later, pt improved.


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