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This is VAERS ID 269217

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

269217
VAERS Form:
Age:15.0
Gender:Female
Location:Oregon
Vaccinated:2006-09-27
Onset:2006-09-28
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0637F / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Injection site pain, Nausea, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: UNK
CDC 'Split Type':

Write-up:Information has been received from a physician''''s nurse concerning a 15 year old female who on 27 Sep 2006 was vaccinated intramuscularly with HPV vaccine (lot # 653937/0637F). On 28 Sept 2006 the patient experienced nausea, fever and soreness at the inje"ction site. Unspecified medical attention was sought. At the time of this report, the outcome of the events was unknown.


Changed on 12/8/2009

269217 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Oregon
Vaccinated:2006-09-27
Onset:2006-09-28
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. 0637F / - - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Injection site pain, Nausea, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: UNK
CDC 'Split Type': (blank) WAES0611USA06105

Write-up:Information has been received from a physician''''s physician''s nurse concerning a 15 year old female who on 27 Sep 2006 was vaccinated intramuscularly with HPV vaccine (lot # 653937/0637F). On 28 Sept 2006 the patient experienced nausea, fever and soreness at the inje"ction injection site. Unspecified medical attention was sought. At the time of this report, the outcome of the events was unknown.


Changed on 1/5/2010

269217 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Oregon
Vaccinated:2006-09-27
Onset:2006-09-28 2006-09-27
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / - - / IM

Administered by: Other Private      Purchased by: Other Private
Symptoms: Injection site pain, Nausea, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Pain ankle
Preexisting Conditions: UNK Hypersensitivity; Attention deficit/hyperactivity disorder
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0611USA06105

Write-up:Information has been received from a physician''s nurse concerning a 15 year old female who on 27 Sep 2006 was vaccinated intramuscularly with HPV vaccine (lot # 653937/0637F). On 28 Sept 2006 the patient experienced nausea, fever and soreness at the injection site. Unspecified medical attention was sought. At the time of this report, the outcome of the events was unknown.


Changed on 6/14/2014

269217 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Oregon
Vaccinated:2006-09-27
Onset:2006-09-27
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Injection site pain, Nausea, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Pain ankle
Preexisting Conditions: Hypersensitivity; Attention deficit/hyperactivity disorder
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0611USA06105

Write-up:Information has been received from a physician''s nurse concerning a 15 year old female who on 27 Sep 2006 was vaccinated intramuscularly with HPV vaccine (lot # 653937/0637F). On 28 Sept 2006 the patient experienced nausea, fever and soreness at the injection site. Unspecified medical attention was sought. At the time of this report, the outcome of the events was unknown.


Changed on 5/14/2017

269217 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Oregon
Vaccinated:2006-09-27
Onset:2006-09-27
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / - - / IM

Administered by: Private      Purchased by: Private
Symptoms: Injection site pain, Nausea, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Pain ankle
Preexisting Conditions: Hypersensitivity; Attention deficit/hyperactivity disorder
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0611USA06105

Write-up:Information has been received from a physician''s nurse concerning a 15 year old female who on 27 Sep 2006 was vaccinated intramuscularly with HPV vaccine (lot # 653937/0637F). On 28 Sept 2006 the patient experienced nausea, fever and soreness at the injection site. Unspecified medical attention was sought. At the time of this report, the outcome of the events was unknown.


Changed on 9/14/2017

269217 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:Oregon
Vaccinated:2006-09-27
Onset:2006-09-27
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0637F / - UNK - / IM

Administered by: Private      Purchased by: Private
Symptoms: Injection site pain, Nausea, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Pain ankle
Preexisting Conditions: Hypersensitivity; Attention deficit/hyperactivity disorder
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0611USA06105

Write-up:Information has been received from a physician''s nurse concerning a 15 year old female who on 27 Sep 2006 was vaccinated intramuscularly with HPV vaccine (lot # 653937/0637F). On 28 Sept 2006 the patient experienced nausea, fever and soreness at the injection site. Unspecified medical attention was sought. At the time of this report, the outcome of the events was unknown.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=269217&WAYBACKHISTORY=ON


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