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This is VAERS ID 268513

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

268513
VAERS Form:
Age:14.0
Gender:Female
Location:Minnesota
Vaccinated:2006-12-04
Onset:2006-12-05
Submitted:2006-12-06
Entered:2006-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0637F / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, INC. U2094AA / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Injection site reaction, 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Allergic to Septra
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up:Local pruritic reaction at injection site without erythema, edema left deltoid.


Changed on 12/8/2009

268513 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Minnesota
Vaccinated:2006-12-04
Onset:2006-12-05
Submitted:2006-12-06
Entered:2006-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. 0637F / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR, INC. AVENTIS PASTEUR U2094AA / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Injection site reaction, 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Allergic to Septra
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up:Local pruritic reaction at injection site without erythema, edema left deltoid.


Changed on 4/7/2010

268513 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Minnesota
Vaccinated:2006-12-04
Onset:2006-12-05
Submitted:2006-12-06
Entered:2006-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U2094AA / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Injection site reaction, 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Allergic to Septra
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up:Local pruritic reaction at injection site without erythema, edema left deltoid.


Changed on 5/14/2017

268513 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Minnesota
Vaccinated:2006-12-04
Onset:2006-12-05
Submitted:2006-12-06
Entered:2006-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U2094AA / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Injection site reaction, 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Allergic to Septra
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up:Local pruritic reaction at injection site without erythema, edema left deltoid.


Changed on 9/14/2017

268513 Before After
VAERS Form:(blank) 1
Age:14.0
Gender:Female
Location:Minnesota
Vaccinated:2006-12-04
Onset:2006-12-05
Submitted:2006-12-06
Entered:2006-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / 0 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2094AA / 0 1 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Injection site reaction, 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Allergic to Septra
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up:Local pruritic reaction at injection site without erythema, edema left deltoid.


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