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This is VAERS ID 269211

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

269211
VAERS Form:
Age:13.0
Gender:Female
Location:Tennessee
Vaccinated:2006-11-14
Onset:2006-11-15
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0955F / - - / -

Administered by: Other      Purchased by: Unknown
Symptoms: Euphoric mood, Malaise, Nausea, Abnormal behaviour

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: NONE
Current Illness:
Preexisting Conditions: Penicillin allergy, drug hypersensitivity
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up:Information has been received from a registered nurse concerning a 13 year old female with a penicillin allergy and drug hypersensitivity to Zithromax. On 14 Nov 2006, the patient was vaccinated with Gardasil (yeast) ( Lot # 653978/0955F). There were no c"oncomitant medications reported. On 15 Nov 2006, the patient was noted to be very emotional, nauseated, felt dazed and /"high/". The patient sought unspecified medical attention. No treatment was required. On 16 Nov 2006, the patient had recovered from th


Changed on 12/8/2009

269211 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Tennessee
Vaccinated:2006-11-14
Onset:2006-11-15
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. 0955F / - - / -

Administered by: Other      Purchased by: Unknown Other
Symptoms: Euphoric mood, Malaise, Nausea, Abnormal behaviour

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: NONE
Current Illness:
Preexisting Conditions: Penicillin allergy, drug hypersensitivity
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': (blank) WAES0611USA05160

Write-up:Information has been received from a registered nurse concerning a 13 year old female with a penicillin allergy and drug hypersensitivity to Zithromax. On 14 Nov 2006, the patient was vaccinated with Gardasil (yeast) ( Lot # 653978/0955F). There were no c"oncomitant concomitant medications reported. On 15 Nov 2006, the patient was noted to be very emotional, nauseated, felt dazed and /"high/". "high". The patient sought unspecified medical attention. No treatment was required. On 16 Nov 2006, the patient had recovered from th the events. Additional information has been requested.


Changed on 1/5/2010

269211 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Tennessee
Vaccinated:2006-11-14
Onset:2006-11-15
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / - - / -

Administered by: Other Private      Purchased by: Other
Symptoms: Euphoric mood, Malaise, Nausea, Abnormal behaviour

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: NONE
Current Illness:
Preexisting Conditions: Penicillin allergy, drug hypersensitivity
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0611USA05160

Write-up:Information has been received from a registered nurse concerning a 13 year old female with a penicillin allergy and drug hypersensitivity to Zithromax. On 14 Nov 2006, the patient was vaccinated with Gardasil (yeast) ( Lot # 653978/0955F). There were no concomitant medications reported. On 15 Nov 2006, the patient was noted to be very emotional, nauseated, felt dazed and "high". The patient sought unspecified medical attention. No treatment was required. On 16 Nov 2006, the patient had recovered from the events. Additional information has been requested.


Changed on 6/14/2014

269211 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Tennessee
Vaccinated:2006-11-14
Onset:2006-11-15
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / - - / -

Administered by: Private      Purchased by: Other
Symptoms: Euphoric mood, Malaise, Nausea, Abnormal behaviour

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: NONE
Current Illness:
Preexisting Conditions: Penicillin allergy, drug hypersensitivity
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0611USA05160

Write-up:Information has been received from a registered nurse concerning a 13 year old female with a penicillin allergy and drug hypersensitivity to Zithromax. On 14 Nov 2006, the patient was vaccinated with Gardasil (yeast) ( Lot # 653978/0955F). There were no concomitant medications reported. On 15 Nov 2006, the patient was noted to be very emotional, nauseated, felt dazed and "high". The patient sought unspecified medical attention. No treatment was required. On 16 Nov 2006, the patient had recovered from the events. Additional information has been requested.


Changed on 5/14/2017

269211 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Tennessee
Vaccinated:2006-11-14
Onset:2006-11-15
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / - - / -

Administered by: Private      Purchased by: Other
Symptoms: Euphoric mood, Malaise, Nausea, Abnormal behaviour

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: NONE
Current Illness:
Preexisting Conditions: Penicillin allergy, drug hypersensitivity
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0611USA05160

Write-up:Information has been received from a registered nurse concerning a 13 year old female with a penicillin allergy and drug hypersensitivity to Zithromax. On 14 Nov 2006, the patient was vaccinated with Gardasil (yeast) ( Lot # 653978/0955F). There were no concomitant medications reported. On 15 Nov 2006, the patient was noted to be very emotional, nauseated, felt dazed and "high". The patient sought unspecified medical attention. No treatment was required. On 16 Nov 2006, the patient had recovered from the events. Additional information has been requested.


Changed on 9/14/2017

269211 Before After
VAERS Form:(blank) 1
Age:13.0
Gender:Female
Location:Tennessee
Vaccinated:2006-11-14
Onset:2006-11-15
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / - UNK - / -

Administered by: Private      Purchased by: Other
Symptoms: Euphoric mood, Malaise, Nausea, Abnormal behaviour

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: NONE
Current Illness:
Preexisting Conditions: Penicillin allergy, drug hypersensitivity
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0611USA05160

Write-up:Information has been received from a registered nurse concerning a 13 year old female with a penicillin allergy and drug hypersensitivity to Zithromax. On 14 Nov 2006, the patient was vaccinated with Gardasil (yeast) ( Lot # 653978/0955F). There were no concomitant medications reported. On 15 Nov 2006, the patient was noted to be very emotional, nauseated, felt dazed and "high". The patient sought unspecified medical attention. No treatment was required. On 16 Nov 2006, the patient had recovered from the events. Additional information has been requested.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=269211&WAYBACKHISTORY=ON


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