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This is VAERS ID 269194

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

269194
VAERS Form:
Age:
Gender:Unknown
Location:Wisconsin
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. - / 1 - / -

Administered by: Other      Purchased by: Unknown
Symptoms: Abdominal pain, Pelvic pain

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up:Information had been received from a physician concerning a patient who on an unspecified date was vaccinated with the second dose of Gardasil (yeast). Subsequently the patient experienced abdominal pain and suprapubic pain that radiated to the vaginal re"gion. No further details were provided. Additional information has been requested.


Changed on 12/8/2009

269194 Before After
VAERS Form:
Age:
Gender:Unknown
Location:Wisconsin
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. - / 1 - / -

Administered by: Other      Purchased by: Unknown Other
Symptoms: Abdominal pain, Pelvic pain

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': (blank) WAES0611USA04226

Write-up:Information had been received from a physician concerning a patient who on an unspecified date was vaccinated with the second dose of Gardasil (yeast). Subsequently the patient experienced abdominal pain and suprapubic pain that radiated to the vaginal re"gion. region. No further details were provided. Additional information has been requested.


Changed on 1/5/2010

269194 Before After
VAERS Form:
Age:(blank) 24.0
Gender:Unknown Female
Location:Wisconsin
Vaccinated:0000-00-00 2006-10-24
Onset:0000-00-00 2006-10-24
Submitted:2006-12-14 2007-04-06
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - 0637F / 1 - UN / - IM

Administered by: Other Private      Purchased by: Other Private
Symptoms: Abdominal pain, Pelvic pain

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No 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: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK None
CDC 'Split Type': WAES0611USA04226

Write-up:Information had been received from a physician concerning a patient who on an unspecified date was vaccinated with the second dose of Gardasil (yeast). Subsequently the patient experienced abdominal pain and suprapubic pain that radiated to the vaginal region. No further details were provided. 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 physician concerning a patient who on 24-OCT-2006 was vaccinated intramuscularly with the second dose of GARDASIL (lot # 653937/0637F). Subseqently on 24-OCT-2006, the patient experienced abdominal pain. The abdominal pain was described as being located at the umbilicus to genital area. The abdominal pain spontaneously resolved 3 days after the vaccination. No further details were provided.


Changed on 7/31/2010

269194 Before After
VAERS Form:
Age:24.0
Gender:Female
Location:Wisconsin
Vaccinated:2006-10-24
Onset:2006-10-24
Submitted:2007-04-06
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / 1 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Suprapubic 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type': WAES0611USA04226

Write-up:Information had been received from a physician concerning a patient who on an unspecified date was vaccinated with the second dose of Gardasil (yeast). Subsequently the patient experienced abdominal pain and suprapubic pain that radiated to the vaginal region. No further details were provided. 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 physician concerning a patient who on 24-OCT-2006 was vaccinated intramuscularly with the second dose of GARDASIL (lot # 653937/0637F). Subseqently on 24-OCT-2006, the patient experienced abdominal pain. The abdominal pain was described as being located at the umbilicus to genital area. The abdominal pain spontaneously resolved 3 days after the vaccination. No further details were provided.


Changed on 6/14/2014

269194 Before After
VAERS Form:
Age:24.0
Gender:Female
Location:Wisconsin
Vaccinated:2006-10-24
Onset:2006-10-24
Submitted:2007-04-06
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / 1 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Suprapubic 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type': WAES0611USA04226

Write-up:Information had been received from a physician concerning a patient who on an unspecified date was vaccinated with the second dose of Gardasil (yeast). Subsequently the patient experienced abdominal pain and suprapubic pain that radiated to the vaginal region. No further details were provided. 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 physician concerning a patient who on 24-OCT-2006 was vaccinated intramuscularly with the second dose of GARDASIL (lot # 653937/0637F). Subseqently on 24-OCT-2006, the patient experienced abdominal pain. The abdominal pain was described as being located at the umbilicus to genital area. The abdominal pain spontaneously resolved 3 days after the vaccination. No further details were provided.


Changed on 5/14/2017

269194 Before After
VAERS Form:
Age:24.0
Gender:Female
Location:Wisconsin
Vaccinated:2006-10-24
Onset:2006-10-24
Submitted:2007-04-06
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / 1 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Suprapubic 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type': WAES0611USA04226

Write-up:Information had been received from a physician concerning a patient who on an unspecified date was vaccinated with the second dose of Gardasil (yeast). Subsequently the patient experienced abdominal pain and suprapubic pain that radiated to the vaginal region. No further details were provided. 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 physician concerning a patient who on 24-OCT-2006 was vaccinated intramuscularly with the second dose of GARDASIL (lot # 653937/0637F). Subseqently on 24-OCT-2006, the patient experienced abdominal pain. The abdominal pain was described as being located at the umbilicus to genital area. The abdominal pain spontaneously resolved 3 days after the vaccination. No further details were provided.


Changed on 9/14/2017

269194 Before After
VAERS Form:(blank) 1
Age:24.0
Gender:Female
Location:Wisconsin
Vaccinated:2006-10-24
Onset:2006-10-24
Submitted:2007-04-06
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / 1 2 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Suprapubic 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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type': WAES0611USA04226

Write-up:Information had been received from a physician concerning a patient who on an unspecified date was vaccinated with the second dose of Gardasil (yeast). Subsequently the patient experienced abdominal pain and suprapubic pain that radiated to the vaginal region. No further details were provided. 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 physician concerning a patient who on 24-OCT-2006 was vaccinated intramuscularly with the second dose of GARDASIL (lot # 653937/0637F). Subseqently on 24-OCT-2006, the patient experienced abdominal pain. The abdominal pain was described as being located at the umbilicus to genital area. The abdominal pain spontaneously resolved 3 days after the vaccination. No further details were provided.


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