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This is VAERS ID 269174

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

269174
VAERS Form:
Age:19.0
Gender:Female
Location:Illinois
Vaccinated:2006-11-02
Onset:2006-11-02
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0696F / 0 - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Body temperature decreased, Headache, Nausea, Pain

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: hormonal contraceptives
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Information has been received from a nurse concerning a 19 year old female patient who is the daughter of one of the office employees, who on 02-Nov-2006 was vaccinated with the first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast) (Lot#653650/0696F). Conc"omitant therapy included hormonal contraceptives (unspecified). On 02-Nov-2006 the patient developed nausea, low grade fever, achiness and a headache post vaccination. It was reported that these events continued into the evening on 02-Nov-2006. On 03-Nov-


Changed on 12/8/2009

269174 Before After
VAERS Form:
Age:19.0
Gender:Female
Location:Illinois
Vaccinated:2006-11-02
Onset:2006-11-02
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. 0696F / 0 - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Body temperature decreased, Headache, Nausea, Pain

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: hormonal contraceptives
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) WAES0611USA02205

Write-up:Information has been received from a nurse concerning a 19 year old female patient who is the daughter of one of the office employees, who on 02-Nov-2006 was vaccinated with the first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast) (Lot#653650/0696F). Conc"omitant Concomitant therapy included hormonal contraceptives (unspecified). On 02-Nov-2006 the patient developed nausea, low grade fever, achiness and a headache post vaccination. It was reported that these events continued into the evening on 02-Nov-2006. On 03-Nov- 03-Nov-2006, the next morning the patient had recovered from all of the events. Additional information has been requested.


Changed on 1/5/2010

269174 Before After
VAERS Form:
Age:19.0
Gender:Female
Location:Illinois
Vaccinated:2006-11-02
Onset: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. 0696F / 0 - UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Body temperature decreased, Headache, Nausea, Pain

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: hormonal contraceptives
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES0611USA02205

Write-up:Information has been received from a nurse concerning a 19 year old female patient who is the daughter of one of the office employees, who on 02-Nov-2006 was vaccinated with the first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast) (Lot#653650/0696F). Concomitant therapy included hormonal contraceptives (unspecified). On 02-Nov-2006 the patient developed nausea, low grade fever, achiness and a headache post vaccination. It was reported that these events continued into the evening on 02-Nov-2006. On 03-Nov-2006, the next morning the patient had recovered from all of the events. Additional information has been requested. This is in follow-up to report (s) previously submitted on 12/14/2006. Information has been received from a nurse concerning a 19 year old female patient who is the daughter of one of the office employees, who on 02-NOV-2006 was vaccinated with the first dose of GARDASIL (Lot # 653650/0696F). Concomitant therapy included hormonal contraceptives (unspecified). On 02-NOV-2006 the patient developed nausea, dizziness, low grade fever, achiness and a headache post vaccination. It was reported that these events continued into the evening on 02-NOV-2006. On 03-NOV-2006, the next morning the patient had recovered from all of the events. Additional information has been requested.


Changed on 7/31/2010

269174 Before After
VAERS Form:
Age:19.0
Gender:Female
Location:Illinois
Vaccinated:2006-11-02
Onset:2006-11-02
Submitted:2007-04-06
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0696F / 0 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Dizziness, Headache, Nausea, Pain, Pyrexia

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: hormonal contraceptives
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES0611USA02205

Write-up:Information has been received from a nurse concerning a 19 year old female patient who is the daughter of one of the office employees, who on 02-Nov-2006 was vaccinated with the first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast) (Lot#653650/0696F). Concomitant therapy included hormonal contraceptives (unspecified). On 02-Nov-2006 the patient developed nausea, low grade fever, achiness and a headache post vaccination. It was reported that these events continued into the evening on 02-Nov-2006. On 03-Nov-2006, the next morning the patient had recovered from all of the events. Additional information has been requested. This is in follow-up to report (s) previously submitted on 12/14/2006. Information has been received from a nurse concerning a 19 year old female patient who is the daughter of one of the office employees, who on 02-NOV-2006 was vaccinated with the first dose of GARDASIL (Lot # 653650/0696F). Concomitant therapy included hormonal contraceptives (unspecified). On 02-NOV-2006 the patient developed nausea, dizziness, low grade fever, achiness and a headache post vaccination. It was reported that these events continued into the evening on 02-NOV-2006. On 03-NOV-2006, the next morning the patient had recovered from all of the events. Additional information has been requested.


Changed on 6/14/2014

269174 Before After
VAERS Form:
Age:19.0
Gender:Female
Location:Illinois
Vaccinated:2006-11-02
Onset:2006-11-02
Submitted:2007-04-06
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0696F / 0 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Dizziness, Headache, Nausea, Pain, Pyrexia

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: hormonal contraceptives
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES0611USA02205

Write-up:Information has been received from a nurse concerning a 19 year old female patient who is the daughter of one of the office employees, who on 02-Nov-2006 was vaccinated with the first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast) (Lot#653650/0696F). Concomitant therapy included hormonal contraceptives (unspecified). On 02-Nov-2006 the patient developed nausea, low grade fever, achiness and a headache post vaccination. It was reported that these events continued into the evening on 02-Nov-2006. On 03-Nov-2006, the next morning the patient had recovered from all of the events. Additional information has been requested. This is in follow-up to report (s) previously submitted on 12/14/2006. Information has been received from a nurse concerning a 19 year old female patient who is the daughter of one of the office employees, who on 02-NOV-2006 was vaccinated with the first dose of GARDASIL (Lot # 653650/0696F). Concomitant therapy included hormonal contraceptives (unspecified). On 02-NOV-2006 the patient developed nausea, dizziness, low grade fever, achiness and a headache post vaccination. It was reported that these events continued into the evening on 02-NOV-2006. On 03-NOV-2006, the next morning the patient had recovered from all of the events. Additional information has been requested.


Changed on 5/14/2017

269174 Before After
VAERS Form:
Age:19.0
Gender:Female
Location:Illinois
Vaccinated:2006-11-02
Onset:2006-11-02
Submitted:2007-04-06
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0696F / 0 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Dizziness, Headache, Nausea, Pain, Pyrexia

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: hormonal contraceptives
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES0611USA02205

Write-up:Information has been received from a nurse concerning a 19 year old female patient who is the daughter of one of the office employees, who on 02-Nov-2006 was vaccinated with the first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast) (Lot#653650/0696F). Concomitant therapy included hormonal contraceptives (unspecified). On 02-Nov-2006 the patient developed nausea, low grade fever, achiness and a headache post vaccination. It was reported that these events continued into the evening on 02-Nov-2006. On 03-Nov-2006, the next morning the patient had recovered from all of the events. Additional information has been requested. This is in follow-up to report (s) previously submitted on 12/14/2006. Information has been received from a nurse concerning a 19 year old female patient who is the daughter of one of the office employees, who on 02-NOV-2006 was vaccinated with the first dose of GARDASIL (Lot # 653650/0696F). Concomitant therapy included hormonal contraceptives (unspecified). On 02-NOV-2006 the patient developed nausea, dizziness, low grade fever, achiness and a headache post vaccination. It was reported that these events continued into the evening on 02-NOV-2006. On 03-NOV-2006, the next morning the patient had recovered from all of the events. Additional information has been requested.


Changed on 9/14/2017

269174 Before After
VAERS Form:(blank) 1
Age:19.0
Gender:Female
Location:Illinois
Vaccinated:2006-11-02
Onset:2006-11-02
Submitted:2007-04-06
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0696F / 0 1 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Dizziness, Headache, Nausea, Pain, Pyrexia

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: hormonal contraceptives
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES0611USA02205

Write-up:Information has been received from a nurse concerning a 19 year old female patient who is the daughter of one of the office employees, who on 02-Nov-2006 was vaccinated with the first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast) (Lot#653650/0696F). Concomitant therapy included hormonal contraceptives (unspecified). On 02-Nov-2006 the patient developed nausea, low grade fever, achiness and a headache post vaccination. It was reported that these events continued into the evening on 02-Nov-2006. On 03-Nov-2006, the next morning the patient had recovered from all of the events. Additional information has been requested. This is in follow-up to report (s) previously submitted on 12/14/2006. Information has been received from a nurse concerning a 19 year old female patient who is the daughter of one of the office employees, who on 02-NOV-2006 was vaccinated with the first dose of GARDASIL (Lot # 653650/0696F). Concomitant therapy included hormonal contraceptives (unspecified). On 02-NOV-2006 the patient developed nausea, dizziness, low grade fever, achiness and a headache post vaccination. It was reported that these events continued into the evening on 02-NOV-2006. On 03-NOV-2006, the next morning the patient had recovered from all of the events. Additional information has been requested.


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