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This is VAERS ID 269219

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

269219
VAERS Form:
Age:20.0
Gender:Female
Location:Massachusetts
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. - / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Influenza like illness, Injection site erythema

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: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up:Information has been received from a registered nurse concerning a 20 year old female with no pertinent medical history or drug reactions/allergies who on 14 Nov 2006 was vaccinated intramuscularly with HPV Vaccine. There was no concomitant medications. O"n 15 Nov 2006, about 24 hours later, the patient developed erythema at the injection site and experienced flu like symptoms. Unspecified medical attention was sought. Subsequently, the patient recovered from the erythema at injection site and flu like sym


Changed on 12/8/2009

269219 Before After
VAERS Form:
Age:20.0
Gender:Female
Location:Massachusetts
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. - / - - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Influenza like illness, Injection site erythema

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: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': (blank) WAES0611USA06158

Write-up:Information has been received from a registered nurse concerning a 20 year old female with no pertinent medical history or drug reactions/allergies who on 14 Nov 2006 was vaccinated intramuscularly with HPV Vaccine. There was no concomitant medications. O"n On 15 Nov 2006, about 24 hours later, the patient developed erythema at the injection site and experienced flu like symptoms. Unspecified medical attention was sought. Subsequently, the patient recovered from the erythema at injection site and flu like sym symptoms within 72 hours. Additional information has been requested.


Changed on 6/14/2014

269219 Before After
VAERS Form:
Age:20.0
Gender:Female
Location:Massachusetts
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. - / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Influenza like illness, Injection site erythema

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: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0611USA06158

Write-up:Information has been received from a registered nurse concerning a 20 year old female with no pertinent medical history or drug reactions/allergies who on 14 Nov 2006 was vaccinated intramuscularly with HPV Vaccine. There was no concomitant medications. On 15 Nov 2006, about 24 hours later, the patient developed erythema at the injection site and experienced flu like symptoms. Unspecified medical attention was sought. Subsequently, the patient recovered from the erythema at injection site and flu like symptoms within 72 hours. Additional information has been requested.


Changed on 5/14/2017

269219 Before After
VAERS Form:
Age:20.0
Gender:Female
Location:Massachusetts
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. - / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Influenza like illness, Injection site erythema

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: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0611USA06158

Write-up:Information has been received from a registered nurse concerning a 20 year old female with no pertinent medical history or drug reactions/allergies who on 14 Nov 2006 was vaccinated intramuscularly with HPV Vaccine. There was no concomitant medications. On 15 Nov 2006, about 24 hours later, the patient developed erythema at the injection site and experienced flu like symptoms. Unspecified medical attention was sought. Subsequently, the patient recovered from the erythema at injection site and flu like symptoms within 72 hours. Additional information has been requested.


Changed on 9/14/2017

269219 Before After
VAERS Form:(blank) 1
Age:20.0
Gender:Female
Location:Massachusetts
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. - / - UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Influenza like illness, Injection site erythema

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: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0611USA06158

Write-up:Information has been received from a registered nurse concerning a 20 year old female with no pertinent medical history or drug reactions/allergies who on 14 Nov 2006 was vaccinated intramuscularly with HPV Vaccine. There was no concomitant medications. On 15 Nov 2006, about 24 hours later, the patient developed erythema at the injection site and experienced flu like symptoms. Unspecified medical attention was sought. Subsequently, the patient recovered from the erythema at injection site and flu like symptoms within 72 hours. Additional information has been requested.


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