National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 271904

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 271904
Age:12.0
Gender:Female
Location:Unknown
Vaccinated:2007-01-04
Onset:2007-01-16
Submitted:2007-02-02
Entered:2007-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. DPHVA017A / - LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR U2091AA / - RA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chest X-ray normal, Erythema multiforme, Genital pruritus female, Lip swelling, Pneumonia

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Initial report received on 26 January 2007, from another manufacturer, under the reference number B0454855A, concerning a patient. A 12 year old female patient, was enrolled in the other manufacturers study and received on 04 January 2007 a dose of Menact"ra (lot number U2091AA) intramuscular intro the left upper deltoid and the first dose of study vaccine of Gardasil (lot number DHPVA017A). Since 16 January 2007, since 12 days post administration, the patient had been experiencing pneumonia and developed


Changed on 12/8/2009

VAERS ID: 271904 Before After
Age:12.0
Gender:Female
Location:Unknown
Vaccinated:2007-01-04
Onset:2007-01-16
Submitted:2007-02-02
Entered:2007-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. DPHVA017A / - LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / AVENTIS PASTEUR U2091AA / - RA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chest X-ray normal, Erythema multiforme, Genital pruritus female, Lip swelling, Pneumonia, Pyrexia, Rales, Rash, Urine analysis normal

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': (blank) 200700247

Write-up:Initial report received on 26 January 2007, from another manufacturer, under the reference number B0454855A, concerning a patient. A 12 year old female patient, was enrolled in the other manufacturers study and received on 04 January 2007 a dose of Menact"ra Menactra (lot number U2091AA) intramuscular intro the left upper deltoid and the first dose of study vaccine of Gardasil (lot number DHPVA017A). Since 16 January 2007, since 12 days post administration, the patient had been experiencing pneumonia and developed erythema multiforme and was hospitalized. The patient had been to th e(study) office two days prior to admission with fever, swollen lips and vaginal itch. Exam failed to reveal significant findings other than rales over left posterior lung fields (urine analysis and chest X ray were normal). A clinical diagnosis of rash fitting description of erythema multiform was made. The patient was discharged with symptomatic treatment. She was seen in emergency room the next day and admitted on 18 January 2007 for intravenous treatment (rochepin). The event was unresolved at the time of reporting. The other manufacturer''s investigator considered that there was a reasonable possibility that th erythema multiforme may have been caused by Gardasil and Menactra and was due to pneumonia.


Changed on 4/7/2010

VAERS ID: 271904 Before After
Age:12.0
Gender:Female
Location:Unknown
Vaccinated:2007-01-04
Onset:2007-01-16
Submitted:2007-02-02
Entered:2007-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. DPHVA017A / - LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR U2091AA / - RA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chest X-ray normal, Erythema multiforme, Genital pruritus female, Lip swelling, Pneumonia, Pyrexia, Rales, Rash, Urine analysis normal

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': 200700247

Write-up:Initial report received on 26 January 2007, from another manufacturer, under the reference number B0454855A, concerning a patient. A 12 year old female patient, was enrolled in the other manufacturers study and received on 04 January 2007 a dose of Menactra (lot number U2091AA) intramuscular intro the left upper deltoid and the first dose of study vaccine of Gardasil (lot number DHPVA017A). Since 16 January 2007, since 12 days post administration, the patient had been experiencing pneumonia and developed erythema multiforme and was hospitalized. The patient had been to th e(study) office two days prior to admission with fever, swollen lips and vaginal itch. Exam failed to reveal significant findings other than rales over left posterior lung fields (urine analysis and chest X ray were normal). A clinical diagnosis of rash fitting description of erythema multiform was made. The patient was discharged with symptomatic treatment. She was seen in emergency room the next day and admitted on 18 January 2007 for intravenous treatment (rochepin). The event was unresolved at the time of reporting. The other manufacturer''s investigator considered that there was a reasonable possibility that th erythema multiforme may have been caused by Gardasil and Menactra and was due to pneumonia.


Changed on 5/14/2017

VAERS ID: 271904 Before After
Age:12.0
Gender:Female
Location:Unknown
Vaccinated:2007-01-04
Onset:2007-01-16
Submitted:2007-02-02
Entered:2007-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. DPHVA017A / - LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / AVENTIS PASTEUR SANOFI PASTEUR U2091AA / - RA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Chest X-ray normal, Erythema multiforme, Genital pruritus female, Lip swelling, Pneumonia, Pyrexia, Rales, Rash, Urine analysis normal

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, days: 0     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC 'Split Type': 200700247

Write-up:Initial report received on 26 January 2007, from another manufacturer, under the reference number B0454855A, concerning a patient. A 12 year old female patient, was enrolled in the other manufacturers study and received on 04 January 2007 a dose of Menactra (lot number U2091AA) intramuscular intro the left upper deltoid and the first dose of study vaccine of Gardasil (lot number DHPVA017A). Since 16 January 2007, since 12 days post administration, the patient had been experiencing pneumonia and developed erythema multiforme and was hospitalized. The patient had been to th e(study) office two days prior to admission with fever, swollen lips and vaginal itch. Exam failed to reveal significant findings other than rales over left posterior lung fields (urine analysis and chest X ray were normal). A clinical diagnosis of rash fitting description of erythema multiform was made. The patient was discharged with symptomatic treatment. She was seen in emergency room the next day and admitted on 18 January 2007 for intravenous treatment (rochepin). The event was unresolved at the time of reporting. The other manufacturer''s investigator considered that there was a reasonable possibility that th erythema multiforme may have been caused by Gardasil and Menactra and was due to pneumonia.


New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=271904&WAYBACKHISTORY=ON


Copyright © 2017 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166