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This is VAERS ID 274196

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

274196
VAERS Form:
Age:17.0
Gender:Female
Location:Wisconsin
Vaccinated:2007-01-26
Onset:2007-01-26
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Injection site 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)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up:Information has been received from a physician concerning a 17 year old female who on 26 Jan 2007 was vaccinated intramuscularly with a first 0.5 mL dose of Gardasil. On 26 Jan 2007 the patient developed a rash at her injection site. The patient sought un"specified medical attention. On 27 Jan 2007 the patient recovered. No product quality complaint was involved. Additional information has been requested.


Changed on 12/8/2009

274196 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Wisconsin
Vaccinated:2007-01-26
Onset:2007-01-26
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Injection site 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)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': (blank) WAES0702USA01324

Write-up:Information has been received from a physician concerning a 17 year old female who on 26 Jan 2007 was vaccinated intramuscularly with a first 0.5 mL dose of Gardasil. On 26 Jan 2007 the patient developed a rash at her injection site. The patient sought un"specified unspecified medical attention. On 27 Jan 2007 the patient recovered. No product quality complaint was involved. Additional information has been requested.


Changed on 9/14/2017

274196 Before After
VAERS Form:(blank) 1
Age:17.0
Gender:Female
Location:Wisconsin
Vaccinated:2007-01-26
Onset:2007-01-26
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Injection site 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)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0702USA01324

Write-up:Information has been received from a physician concerning a 17 year old female who on 26 Jan 2007 was vaccinated intramuscularly with a first 0.5 mL dose of Gardasil. On 26 Jan 2007 the patient developed a rash at her injection site. The patient sought unspecified medical attention. On 27 Jan 2007 the patient recovered. No product quality complaint was involved. Additional information has been requested.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=274196&WAYBACKHISTORY=ON


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