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This is VAERS ID 269172

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 269172
Age:14.0
Gender:Female
Location:North Dakota
Vaccinated:2006-11-01
Onset:2006-11-01
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0640F / - UN / -

Administered by: Other      Purchased by: Unknown
Symptoms: Oedema peripheral, Pain, Urticaria

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: DEPO-PROVERA
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up:Information has been received from a physician concerning a 14 year old female who on 01-Nov-2006 was vaccinated with 0.5 ml of HPV rL1 6 11 16 18 VLP vaccine (yeast) (Lot#653650/0640F). At the same time, the patient received medroxyprogesterone acetate ("DEPO-PROVERA) /" in glut/". On 01-Nov-2006 (conflicting information also reported as 02-Nov-2006), the patient developed body aches. On 03-Nov-2006 the patient developed hives all over body and also experienced ankle swelling. The patient sought unspecifi


Changed on 12/8/2009

VAERS ID: 269172 Before After
Age:14.0
Gender:Female
Location:North Dakota
Vaccinated:2006-11-01
Onset:2006-11-01
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. 0640F / - UN / -

Administered by: Other      Purchased by: Unknown Other
Symptoms: Oedema peripheral, Pain, Urticaria

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: DEPO-PROVERA
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC 'Split Type': (blank) WAES0611USA01557

Write-up:Information has been received from a physician concerning a 14 year old female who on 01-Nov-2006 was vaccinated with 0.5 ml of HPV rL1 6 11 16 18 VLP vaccine (yeast) (Lot#653650/0640F). At the same time, the patient received medroxyprogesterone acetate ("DEPO-PROVERA) /" (DEPO-PROVERA) " in glut/". glut". On 01-Nov-2006 (conflicting information also reported as 02-Nov-2006), the patient developed body aches. On 03-Nov-2006 the patient developed hives all over body and also experienced ankle swelling. The patient sought unspecifi unspecified medical attention. At the time of this report, the outcome of the events were unknown. Additional information has been requested.


Changed on 1/5/2010

VAERS ID: 269172 Before After
Age:14.0
Gender:Female
Location:North Dakota
Vaccinated:2006-11-01
Onset:2006-11-01 2006-11-02
Submitted:2006-12-14 2007-04-06
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0640F / - 0 UN / - IM

Administered by: Other Private      Purchased by: Other Private
Symptoms: Oedema peripheral, Pain, Urticaria

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: DEPO-PROVERA
Current Illness: Hypersensitivity
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0611USA01557

Write-up:Information has been received from a physician concerning a 14 year old female who on 01-Nov-2006 was vaccinated with 0.5 ml of HPV rL1 6 11 16 18 VLP vaccine (yeast) (Lot#653650/0640F). At the same time, the patient received medroxyprogesterone acetate (DEPO-PROVERA) " in glut". On 01-Nov-2006 (conflicting information also reported as 02-Nov-2006), the patient developed body aches. On 03-Nov-2006 the patient developed hives all over body and also experienced ankle swelling. The patient sought unspecified medical attention. At the time of this report, the outcome of the events were unknown. Additional information has been requested. This is in follow-up to report (s) previously submitted on 12/14/2006. Initial and follow up information has been received from a physician and a registered nurse concerning a 14 year old female student with an unspecified allery reported as "unknown antibiotic". On 01-NOV-2006, at 4:00 PM, the patient was vaccinated intramuscularly in the left arm with the first 0.5 mL dose of GARDASIL (Lot #653650/0640F). At that same time, the patient received DEPO-PROVERA "in glut". On 02-NOV-2006, the patient developed body aches, swollen ankles and itchy hives on stomach and arms (previously reported as hives all over body). The patient followed up with the physician. At the time of this report, the outcome of the events were unknown. Additional information has been requested.


Changed on 7/31/2010

VAERS ID: 269172 Before After
Age:14.0
Gender:Female
Location:North Dakota
Vaccinated:2006-11-01
Onset:2006-11-02
Submitted:2007-04-06
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0640F / 0 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Joint swelling, Pain, Pruritus, Urticaria

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: DEPO-PROVERA
Current Illness: Hypersensitivity
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0611USA01557

Write-up:Information has been received from a physician concerning a 14 year old female who on 01-Nov-2006 was vaccinated with 0.5 ml of HPV rL1 6 11 16 18 VLP vaccine (yeast) (Lot#653650/0640F). At the same time, the patient received medroxyprogesterone acetate (DEPO-PROVERA) " in glut". On 01-Nov-2006 (conflicting information also reported as 02-Nov-2006), the patient developed body aches. On 03-Nov-2006 the patient developed hives all over body and also experienced ankle swelling. The patient sought unspecified medical attention. At the time of this report, the outcome of the events were unknown. Additional information has been requested. This is in follow-up to report (s) previously submitted on 12/14/2006. Initial and follow up information has been received from a physician and a registered nurse concerning a 14 year old female student with an unspecified allery reported as "unknown antibiotic". On 01-NOV-2006, at 4:00 PM, the patient was vaccinated intramuscularly in the left arm with the first 0.5 mL dose of GARDASIL (Lot #653650/0640F). At that same time, the patient received DEPO-PROVERA "in glut". On 02-NOV-2006, the patient developed body aches, swollen ankles and itchy hives on stomach and arms (previously reported as hives all over body). The patient followed up with the physician. At the time of this report, the outcome of the events were unknown. Additional information has been requested.


Changed on 6/14/2014

VAERS ID: 269172 Before After
Age:14.0
Gender:Female
Location:North Dakota
Vaccinated:2006-11-01
Onset:2006-11-02
Submitted:2007-04-06
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0640F / 0 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Joint swelling, Pain, Pruritus, Urticaria

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: DEPO-PROVERA
Current Illness: Hypersensitivity
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0611USA01557

Write-up:Information has been received from a physician concerning a 14 year old female who on 01-Nov-2006 was vaccinated with 0.5 ml of HPV rL1 6 11 16 18 VLP vaccine (yeast) (Lot#653650/0640F). At the same time, the patient received medroxyprogesterone acetate (DEPO-PROVERA) " in glut". On 01-Nov-2006 (conflicting information also reported as 02-Nov-2006), the patient developed body aches. On 03-Nov-2006 the patient developed hives all over body and also experienced ankle swelling. The patient sought unspecified medical attention. At the time of this report, the outcome of the events were unknown. Additional information has been requested. This is in follow-up to report (s) previously submitted on 12/14/2006. Initial and follow up information has been received from a physician and a registered nurse concerning a 14 year old female student with an unspecified allery reported as "unknown antibiotic". On 01-NOV-2006, at 4:00 PM, the patient was vaccinated intramuscularly in the left arm with the first 0.5 mL dose of GARDASIL (Lot #653650/0640F). At that same time, the patient received DEPO-PROVERA "in glut". On 02-NOV-2006, the patient developed body aches, swollen ankles and itchy hives on stomach and arms (previously reported as hives all over body). The patient followed up with the physician. At the time of this report, the outcome of the events were unknown. Additional information has been requested.


Changed on 5/14/2017

VAERS ID: 269172 Before After
Age:14.0
Gender:Female
Location:North Dakota
Vaccinated:2006-11-01
Onset:2006-11-02
Submitted:2007-04-06
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0640F / 0 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Joint swelling, Pain, Pruritus, Urticaria

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: DEPO-PROVERA
Current Illness: Hypersensitivity
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0611USA01557

Write-up:Information has been received from a physician concerning a 14 year old female who on 01-Nov-2006 was vaccinated with 0.5 ml of HPV rL1 6 11 16 18 VLP vaccine (yeast) (Lot#653650/0640F). At the same time, the patient received medroxyprogesterone acetate (DEPO-PROVERA) " in glut". On 01-Nov-2006 (conflicting information also reported as 02-Nov-2006), the patient developed body aches. On 03-Nov-2006 the patient developed hives all over body and also experienced ankle swelling. The patient sought unspecified medical attention. At the time of this report, the outcome of the events were unknown. Additional information has been requested. This is in follow-up to report (s) previously submitted on 12/14/2006. Initial and follow up information has been received from a physician and a registered nurse concerning a 14 year old female student with an unspecified allery reported as "unknown antibiotic". On 01-NOV-2006, at 4:00 PM, the patient was vaccinated intramuscularly in the left arm with the first 0.5 mL dose of GARDASIL (Lot #653650/0640F). At that same time, the patient received DEPO-PROVERA "in glut". On 02-NOV-2006, the patient developed body aches, swollen ankles and itchy hives on stomach and arms (previously reported as hives all over body). The patient followed up with the physician. At the time of this report, the outcome of the events were unknown. Additional information has been requested.


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