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This is VAERS ID 272504

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

272504
VAERS Form:
Age:13.0
Gender:Female
Location:Florida
Vaccinated:2007-01-05
Onset:2007-01-06
Submitted:2007-02-14
Entered:2007-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / 1 UN / -

Administered by: Private      Purchased by: Unknown
Symptoms: Pain of skin, Pruritus, Rash

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: UNK
Current Illness: Unspecified congenital anomaly of heart; Hypersensitivity
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up:Information has been received from an L.P.N. concerning a 13 year old female student with a congenital heart defect and allergy to contrast dye who on the morning of 05-JAN-2007 between approximately 9-11 a.m. was vaccinated in the left upper arm with her"second dose of Gardasil (yeast), lot#654389/0961F. In the p.m. of 06-JAN-2007 the patient developed skin tender and some skin /"bumps/" with pruritis X 2 days. It was reported that on 09-JAN-2007, the patient recovered. No further information is available


Changed on 12/8/2009

272504 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Florida
Vaccinated:2007-01-05
Onset:2007-01-06
Submitted:2007-02-14
Entered:2007-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / 1 UN / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Pain of skin, Pruritus, Rash

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: UNK
Current Illness: Unspecified congenital anomaly of heart; Hypersensitivity
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': (blank) WAES0701USA03895

Write-up:Information has been received from an L.P.N. concerning a 13 year old female student with a congenital heart defect and allergy to contrast dye who on the morning of 05-JAN-2007 between approximately 9-11 a.m. was vaccinated in the left upper arm with her"second her second dose of Gardasil (yeast), lot#654389/0961F. In the p.m. of 06-JAN-2007 the patient developed skin tender and some skin /"bumps/" "bumps" with pruritis X 2 days. It was reported that on 09-JAN-2007, the patient recovered. No further information is available available.


Changed on 9/14/2017

272504 Before After
VAERS Form:(blank) 1
Age:13.0
Gender:Female
Location:Florida
Vaccinated:2007-01-05
Onset:2007-01-06
Submitted:2007-02-14
Entered:2007-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / 1 2 UN / -

Administered by: Private      Purchased by: Private
Symptoms: Pain of skin, Pruritus, Rash

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: UNK
Current Illness: Unspecified congenital anomaly of heart; Hypersensitivity
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0701USA03895

Write-up:Information has been received from an L.P.N. concerning a 13 year old female student with a congenital heart defect and allergy to contrast dye who on the morning of 05-JAN-2007 between approximately 9-11 a.m. was vaccinated in the left upper arm with her second dose of Gardasil (yeast), lot#654389/0961F. In the p.m. of 06-JAN-2007 the patient developed skin tender and some skin "bumps" with pruritis X 2 days. It was reported that on 09-JAN-2007, the patient recovered. No further information is available.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=272504&WAYBACKHISTORY=ON


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