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This is VAERS ID 270433

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

270433
VAERS Form:
Age:17.0
Gender:Female
Location:New York
Vaccinated:2007-01-03
Onset:2007-01-03
Submitted:2007-01-05
Entered:2007-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUZONE) / AVENTIS PASTEUR U2271AA / - LA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / - RA / -
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR U2116AA / - LA / -

Administered by: Private      Purchased by: Unknown
Symptoms: Injection site erythema, Injection site warmth, Skin ulcer, Tenderness

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:
Current Illness:
Preexisting Conditions: Latex allergy.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Left Deltoid 5cm x 3 1/2 cm circular erythematous tender and warm to touch lesion arm very tender.


Changed on 12/8/2009

270433 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:New York
Vaccinated:2007-01-03
Onset:2007-01-03
Submitted:2007-01-05
Entered:2007-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUZONE) INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U2271AA / - LA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / - RA / -
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR U2116AA / - LA / -

Administered by: Private      Purchased by: Unknown Other
Symptoms: Injection site erythema, Injection site warmth, Skin ulcer, Tenderness

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:
Current Illness:
Preexisting Conditions: Latex allergy.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Left Deltoid 5cm x 3 1/2 cm circular erythematous tender and warm to touch lesion arm very tender.


Changed on 4/7/2010

270433 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:New York
Vaccinated:2007-01-03
Onset:2007-01-03
Submitted:2007-01-05
Entered:2007-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U2271AA / - LA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / - RA / -
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U2116AA / - LA / -

Administered by: Private      Purchased by: Other
Symptoms: Injection site erythema, Injection site warmth, Skin ulcer, Tenderness

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:
Current Illness:
Preexisting Conditions: Latex allergy.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Left Deltoid 5cm x 3 1/2 cm circular erythematous tender and warm to touch lesion arm very tender.


Changed on 7/7/2013

270433 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:New York
Vaccinated:2007-01-03
Onset:2007-01-03
Submitted:2007-01-05
Entered:2007-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U2271AA / - LA / -
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR U2271AA / - LA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / - RA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U2116AA / - LA / -

Administered by: Private      Purchased by: Other
Symptoms: Injection site erythema, Injection site warmth, Skin ulcer, Tenderness

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:
Current Illness:
Preexisting Conditions: Latex allergy.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Left Deltoid 5cm x 3 1/2 cm circular erythematous tender and warm to touch lesion arm very tender.


Changed on 5/14/2017

270433 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:New York
Vaccinated:2007-01-03
Onset:2007-01-03
Submitted:2007-01-05
Entered:2007-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / AVENTIS PASTEUR SANOFI PASTEUR U2271AA / - LA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / - RA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U2116AA / - LA / -

Administered by: Private      Purchased by: Other
Symptoms: Injection site erythema, Injection site warmth, Skin ulcer, Tenderness

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:
Current Illness:
Preexisting Conditions: Latex allergy.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Left Deltoid 5cm x 3 1/2 cm circular erythematous tender and warm to touch lesion arm very tender.


Changed on 9/14/2017

270433 Before After
VAERS Form:(blank) 1
Age:17.0
Gender:Female
Location:New York
Vaccinated:2007-01-03
Onset:2007-01-03
Submitted:2007-01-05
Entered:2007-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2271AA / - UNK LA / -
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / - UNK RA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2116AA / - UNK LA / -

Administered by: Private      Purchased by: Other
Symptoms: Injection site erythema, Injection site warmth, Skin ulcer, Tenderness

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:
Current Illness:
Preexisting Conditions: Latex allergy.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Left Deltoid 5cm x 3 1/2 cm circular erythematous tender and warm to touch lesion arm very tender.


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