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This is VAERS ID 272237

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

272237
VAERS Form:
Age:39.0
Gender:Female
Location:Texas
Vaccinated:2007-01-30
Onset:0000-00-00
Submitted:2007-02-08
Entered:2007-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0014U / 1 RA / -

Administered by: Private      Purchased by: Unknown
Symptoms: Erythema multiforme, Hypersensitivity

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:See note (attached) 02/15/2007-record received and reviewed. Office visit of 02/08/07-Assessment. Allergic reaction on chest back and left arm. Patient thinks it is related to Gardasil. Received treatment in Mexico. Treated with Betamethasone. Diagnosed w"ith erythema multiforme. Right arm at injection site is not irritated or edematous. Allergic reaction mostly in the contralateral side.


Changed on 12/8/2009

272237 Before After
VAERS Form:
Age:39.0
Gender:Female
Location:Texas
Vaccinated:2007-01-30
Onset:0000-00-00
Submitted:2007-02-08
Entered:2007-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0014U / 1 RA / -

Administered by: Private      Purchased by: Unknown
Symptoms: Erythema multiforme, Hypersensitivity

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:See note (attached) 02/15/2007-record received and reviewed. Office visit of 02/08/07-Assessment. Allergic reaction on chest back and left arm. Patient thinks it is related to Gardasil. Received treatment in Mexico. Treated with Betamethasone. Diagnosed w"ith with erythema multiforme. Right arm at injection site is not irritated or edematous. Allergic reaction mostly in the contralateral side.


Changed on 12/7/2010

272237 Before After
VAERS Form:
Age:39.0
Gender:Female
Location:Texas
Vaccinated:2007-01-30
Onset:0000-00-00
Submitted:2007-02-08
Entered:2007-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0014U / 1 RA / -

Administered by: Private      Purchased by: Unknown
Symptoms: Erythema multiforme, Hypersensitivity

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:See note (attached) 02/15/2007-record received and reviewed. Office visit of 02/08/07-Assessment. Allergic reaction on chest back and left arm. Patient thinks it is related to Gardasil. Received treatment in Mexico. Treated with Betamethasone. Diagnosed with erythema multiforme. Right arm at injection site is not irritated or edematous. Allergic reaction mostly in the contralateral side.


Changed on 4/13/2011

272237 Before After
VAERS Form:
Age:39.0
Gender:Female
Location:Texas
Vaccinated:2007-01-30
Onset:0000-00-00
Submitted:2007-02-08
Entered:2007-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0014U / 1 RA / -

Administered by: Private      Purchased by: Unknown
Symptoms: Erythema multiforme, Hypersensitivity

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:See note (attached) 02/15/2007-record received and reviewed. Office visit of 02/08/07-Assessment. Allergic reaction on chest back and left arm. Patient thinks it is related to Gardasil. Received treatment in Mexico. Treated with Betamethasone. Diagnosed with erythema multiforme. Right arm at injection site is not irritated or edematous. Allergic reaction mostly in the contralateral side.


Changed on 5/13/2011

272237 Before After
VAERS Form:
Age:39.0
Gender:Female
Location:Texas
Vaccinated:2007-01-30
Onset:0000-00-00
Submitted:2007-02-08
Entered:2007-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0014U / 1 RA / -

Administered by: Private      Purchased by: Unknown
Symptoms: Erythema multiforme, Hypersensitivity

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:See note (attached) 02/15/2007-record received and reviewed. Office visit of 02/08/07-Assessment. Allergic reaction on chest back and left arm. Patient thinks it is related to Gardasil. Received treatment in Mexico. Treated with Betamethasone. Diagnosed with erythema multiforme. Right arm at injection site is not irritated or edematous. Allergic reaction mostly in the contralateral side.


Changed on 6/11/2011

272237 Before After
VAERS Form:
Age:39.0
Gender:Female
Location:Texas
Vaccinated:2007-01-30
Onset:0000-00-00
Submitted:2007-02-08
Entered:2007-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0014U / 1 RA / -

Administered by: Private      Purchased by: Unknown
Symptoms: Erythema multiforme, Hypersensitivity

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:See note (attached) 02/15/2007-record received and reviewed. Office visit of 02/08/07-Assessment. Allergic reaction on chest back and left arm. Patient thinks it is related to Gardasil. Received treatment in Mexico. Treated with Betamethasone. Diagnosed with erythema multiforme. Right arm at injection site is not irritated or edematous. Allergic reaction mostly in the contralateral side.


Changed on 2/14/2017

272237 Before After
VAERS Form:
Age:39.0
Gender:Female
Location:Texas
Vaccinated:2007-01-30
Onset:0000-00-00
Submitted:2007-02-08
Entered:2007-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0014U / 1 RA / -

Administered by: Private      Purchased by: Unknown
Symptoms: Erythema multiforme, Hypersensitivity

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:See note (attached) 02/15/2007-record received and reviewed. Office visit of 02/08/07-Assessment. Allergic reaction on chest back and left arm. Patient thinks it is related to Gardasil. Received treatment in Mexico. Treated with Betamethasone. Diagnosed with erythema multiforme. Right arm at injection site is not irritated or edematous. Allergic reaction mostly in the contralateral side.


Changed on 9/14/2017

272237 Before After
VAERS Form:(blank) 1
Age:39.0
Gender:Female
Location:Texas
Vaccinated:2007-01-30
Onset:0000-00-00
Submitted:2007-02-08
Entered:2007-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0014U / 1 2 RA / -

Administered by: Private      Purchased by: Unknown
Symptoms:

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:See note (attached) 02/15/2007-record received and reviewed. Office visit of 02/08/07-Assessment. Allergic reaction on chest back and left arm. Patient thinks it is related to Gardasil. Received treatment in Mexico. Treated with Betamethasone. Diagnosed with erythema multiforme. Right arm at injection site is not irritated or edematous. Allergic reaction mostly in the contralateral side.


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