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This is VAERS ID 268286

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

268286
VAERS Form:
Age:13.0
Gender:Female
Location:Tennessee
Vaccinated:2006-10-27
Onset:2006-10-27
Submitted:2006-11-30
Entered:2006-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0702F / 0 UN / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Hypersensitivity, Injection site rash, Wheezing

Life Threatening? Yes
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Penicillin allergy
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Information has been received from a registered nurse concerning a 13 year old female with an allergy to amoxicillin who on 10/27/06 was vaccinated IM with the first dose of HPV vaccine (lot 653650/0702F). There was no concomitant medications. On 10/27/06"approx 10 minutes after the injection, the pt started to break out in a rash around the injection site. The pt then started to wheeze. The pt was given Benadryl and Depo Medrol injection. however continued to wheeze. The wheeze was then relieved by a unit


Changed on 12/8/2009

268286 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Tennessee
Vaccinated:2006-10-27
Onset:2006-10-27
Submitted:2006-11-30
Entered:2006-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. 0702F / 0 UN / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Hypersensitivity, Injection site rash, Wheezing

Life Threatening? Yes
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Penicillin allergy
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) WAES0611USA06133

Write-up:Information has been received from a registered nurse concerning a 13 year old female with an allergy to amoxicillin who on 10/27/06 was vaccinated IM with the first dose of HPV vaccine (lot 653650/0702F). There was no concomitant medications. On 10/27/06"approx 10/27/06 approx 10 minutes after the injection, the pt started to break out in a rash around the injection site. The pt then started to wheeze. The pt was given Benadryl and Depo Medrol injection. however continued to wheeze. The wheeze was then relieved by a unit of Xopenex nebulizer treatment, but after ten minutes the pt started to wheeze again. The pt went to the ER and was admitted to the hospital. The nurse reported that th event was that of a standard allergic reaction. The pt was released from the hospital the next day, however had to continue with albuterol inhaler and prednisone therapy. The pt recovered by 10/29/06 and had not experienced any further complications. The nurse reported that the pt would not be receiving any further vaccinations with HPV vaccine. The events were felt to be other important medical events (OMIC) and immediately life threatening. Additional information has been requested.


Changed on 9/14/2017

268286 Before After
VAERS Form:(blank) 1
Age:13.0
Gender:Female
Location:Tennessee
Vaccinated:2006-10-27
Onset:2006-10-27
Submitted:2006-11-30
Entered:2006-12-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0702F / 0 1 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Hypersensitivity, Injection site rash, Wheezing

Life Threatening? Yes
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Penicillin allergy
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES0611USA06133

Write-up:Information has been received from a registered nurse concerning a 13 year old female with an allergy to amoxicillin who on 10/27/06 was vaccinated IM with the first dose of HPV vaccine (lot 653650/0702F). There was no concomitant medications. On 10/27/06 approx 10 minutes after the injection, the pt started to break out in a rash around the injection site. The pt then started to wheeze. The pt was given Benadryl and Depo Medrol injection. however continued to wheeze. The wheeze was then relieved by a unit of Xopenex nebulizer treatment, but after ten minutes the pt started to wheeze again. The pt went to the ER and was admitted to the hospital. The nurse reported that th event was that of a standard allergic reaction. The pt was released from the hospital the next day, however had to continue with albuterol inhaler and prednisone therapy. The pt recovered by 10/29/06 and had not experienced any further complications. The nurse reported that the pt would not be receiving any further vaccinations with HPV vaccine. The events were felt to be other important medical events (OMIC) and immediately life threatening. Additional information has been requested.


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