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This is VAERS ID 270784

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

270784
VAERS Form:
Age:13.5
Gender:Female
Location:Oregon
Vaccinated:2006-12-22
Onset:2006-12-22
Submitted:2007-01-08
Entered:2007-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Dizziness, Erythema, Pallor, Palpitations, Pyrexia

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: NONE
Current Illness: NONE
Preexisting Conditions: History of Dysplasia (hips)
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up:5 hours after receiving HPV pt had low grade fever (99), felt dizzy, pale, had a blotchy red rash on both arms (upper) onto back. No rash elevation, no hives. Pt went to bed, rash was gone by am without further side effects. During episode heart was also"pounding.


Changed on 12/8/2009

270784 Before After
VAERS Form:
Age:13.5
Gender:Female
Location:Oregon
Vaccinated:2006-12-22
Onset:2006-12-22
Submitted:2007-01-08
Entered:2007-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / 0 LA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Dizziness, Erythema, Pallor, Palpitations, Pyrexia, Rash, Rash macular

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: NONE
Current Illness: NONE
Preexisting Conditions: History of Dysplasia (hips)
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up:5 hours after receiving HPV pt had low grade fever (99), felt dizzy, pale, had a blotchy red rash on both arms (upper) onto back. No rash elevation, no hives. Pt went to bed, rash was gone by am without further side effects. During episode heart was also"pounding. also pounding.


Changed on 9/14/2017

270784 Before After
VAERS Form:(blank) 1
Age:13.5
Gender:Female
Location:Oregon
Vaccinated:2006-12-22
Onset:2006-12-22
Submitted:2007-01-08
Entered:2007-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / 0 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Dizziness, Erythema, Pallor, Palpitations, Pyrexia, Rash, Rash macular

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: NONE
Current Illness: NONE
Preexisting Conditions: History of Dysplasia (hips)
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up:5 hours after receiving HPV pt had low grade fever (99), felt dizzy, pale, had a blotchy red rash on both arms (upper) onto back. No rash elevation, no hives. Pt went to bed, rash was gone by am without further side effects. During episode heart was also pounding.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=270784&WAYBACKHISTORY=ON


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