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This is VAERS ID 269185

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

269185
VAERS Form:
Age:
Gender:Female
Location:Illinois
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. - / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Rash

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

Write-up:Information has been received from a physician concerning a female patient (demographics not provided) who on an unspecified date was vaccinated with the first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast) (Lot# not provided). Subsequently the patient de"veloped a rash on her face and stomach. The patient sought unspecified medical advice. Additional information has been requested.


Changed on 12/8/2009

269185 Before After
VAERS Form:
Age:
Gender:Female
Location:Illinois
Vaccinated:0000-00-00
Onset:0000-00-00
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. - / - - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Rash

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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) WAES0611USA03436

Write-up:Information has been received from a physician concerning a female patient (demographics not provided) who on an unspecified date was vaccinated with the first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast) (Lot# not provided). Subsequently the patient de"veloped developed a rash on her face and stomach. The patient sought unspecified medical advice. Additional information has been requested.


Changed on 9/14/2017

269185 Before After
VAERS Form:(blank) 1
Age:
Gender:Female
Location:Illinois
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Rash

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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES0611USA03436

Write-up:Information has been received from a physician concerning a female patient (demographics not provided) who on an unspecified date was vaccinated with the first dose of HPV rL1 6 11 16 18 VLP vaccine (yeast) (Lot# not provided). Subsequently the patient developed a rash on her face and stomach. The patient sought unspecified medical advice. Additional information has been requested.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=269185&WAYBACKHISTORY=ON


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