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This is VAERS ID 274209

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

274209
VAERS Form:
Age:11.0
Gender:Male
Location:New Jersey
Vaccinated:2007-02-07
Onset:2007-02-12
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / -

Administered by: Other      Purchased by: Unknown
Symptoms: Asthenia, Fatigue, Nausea, Pain, Wrong drug administered

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? No
Previous Vaccinations:
Other Medications: Allergenic extract, Zyrtec, Prilosec, Paxil
Current Illness: Pollen allergy, House dust allergy, Food allergy, Acid reflux (Oesophageal), hypersensitivity, asthma, anxiety disorder.
Preexisting Conditions: Convulsion
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type':

Write-up:Information has been received from the mother of an 11 year old male with severe acid reflux and possibly a hiatal hernia, severe allergies to many different things such as pollen, dust, and various foods, mild asthma, anxiety problems and a history of se"izure as an infant after DPT vaccination, who on 07-FEB-2007 was vaccinated with a dose of Gardasil by mistake. Concomitant therapy included ZYRTEC, PAXIL, PRILOSEC and different allergy shots. The report stated that her son was supposed to have received


Changed on 12/8/2009

274209 Before After
VAERS Form:
Age:11.0 10.0
Gender:Male
Location:New Jersey
Vaccinated:2007-02-07
Onset:2007-02-12
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / -

Administered by: Other      Purchased by: Unknown Other
Symptoms: Asthenia, Fatigue, Nausea, Pain, Wrong drug administered

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? No
Previous Vaccinations:
Other Medications: Allergenic extract, Zyrtec, Prilosec, Paxil
Current Illness: Pollen allergy, House dust allergy, Food allergy, Acid reflux (Oesophageal), hypersensitivity, asthma, anxiety disorder.
Preexisting Conditions: Convulsion
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': (blank) WAES0702USA01859

Write-up:Information has been received from the mother of an 11 year old male with severe acid reflux and possibly a hiatal hernia, severe allergies to many different things such as pollen, dust, and various foods, mild asthma, anxiety problems and a history of se"izure seizure as an infant after DPT vaccination, who on 07-FEB-2007 was vaccinated with a dose of Gardasil by mistake. Concomitant therapy included ZYRTEC, PAXIL, PRILOSEC and different allergy shots. The report stated that her son was supposed to have received an unspecified hepatitis vaccine. On 12-FEB-2007 the patient was feeling achy, weak, tired and nauseous. She also stated that she was not sure that these symptoms were related to the vaccine. Medical attention was sought. The patient was reported as not recovered at the time of this report. Additional information has been requested.


Changed on 6/14/2014

274209 Before After
VAERS Form:
Age:10.0
Gender:Male
Location:New Jersey
Vaccinated:2007-02-07
Onset:2007-02-12
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Fatigue, Nausea, Pain, Wrong drug administered

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? No
Previous Vaccinations:
Other Medications: Allergenic extract, Zyrtec, Prilosec, Paxil
Current Illness: Pollen allergy, House dust allergy, Food allergy, Acid reflux (Oesophageal), hypersensitivity, asthma, anxiety disorder.
Preexisting Conditions: Convulsion
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0702USA01859

Write-up:Information has been received from the mother of an 11 year old male with severe acid reflux and possibly a hiatal hernia, severe allergies to many different things such as pollen, dust, and various foods, mild asthma, anxiety problems and a history of seizure as an infant after DPT vaccination, who on 07-FEB-2007 was vaccinated with a dose of Gardasil by mistake. Concomitant therapy included ZYRTEC, PAXIL, PRILOSEC and different allergy shots. The report stated that her son was supposed to have received an unspecified hepatitis vaccine. On 12-FEB-2007 the patient was feeling achy, weak, tired and nauseous. She also stated that she was not sure that these symptoms were related to the vaccine. Medical attention was sought. The patient was reported as not recovered at the time of this report. Additional information has been requested.


Changed on 5/14/2017

274209 Before After
VAERS Form:
Age:10.0
Gender:Male
Location:New Jersey
Vaccinated:2007-02-07
Onset:2007-02-12
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Fatigue, Nausea, Pain, Wrong drug administered

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? No
Previous Vaccinations:
Other Medications: Allergenic extract, Zyrtec, Prilosec, Paxil
Current Illness: Pollen allergy, House dust allergy, Food allergy, Acid reflux (Oesophageal), hypersensitivity, asthma, anxiety disorder.
Preexisting Conditions: Convulsion
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0702USA01859

Write-up:Information has been received from the mother of an 11 year old male with severe acid reflux and possibly a hiatal hernia, severe allergies to many different things such as pollen, dust, and various foods, mild asthma, anxiety problems and a history of seizure as an infant after DPT vaccination, who on 07-FEB-2007 was vaccinated with a dose of Gardasil by mistake. Concomitant therapy included ZYRTEC, PAXIL, PRILOSEC and different allergy shots. The report stated that her son was supposed to have received an unspecified hepatitis vaccine. On 12-FEB-2007 the patient was feeling achy, weak, tired and nauseous. She also stated that she was not sure that these symptoms were related to the vaccine. Medical attention was sought. The patient was reported as not recovered at the time of this report. Additional information has been requested.


Changed on 9/14/2017

274209 Before After
VAERS Form:(blank) 1
Age:10.0
Gender:Male
Location:New Jersey
Vaccinated:2007-02-07
Onset:2007-02-12
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 1 UN / -

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Fatigue, Nausea, Pain, Wrong drug administered

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? No
Previous Vaccinations:
Other Medications: Allergenic extract, Zyrtec, Prilosec, Paxil
Current Illness: Pollen allergy, House dust allergy, Food allergy, Acid reflux (Oesophageal), hypersensitivity, asthma, anxiety disorder.
Preexisting Conditions: Convulsion
Allergies:
Diagnostic Lab Data: UNK
CDC 'Split Type': WAES0702USA01859

Write-up:Information has been received from the mother of an 11 year old male with severe acid reflux and possibly a hiatal hernia, severe allergies to many different things such as pollen, dust, and various foods, mild asthma, anxiety problems and a history of seizure as an infant after DPT vaccination, who on 07-FEB-2007 was vaccinated with a dose of Gardasil by mistake. Concomitant therapy included ZYRTEC, PAXIL, PRILOSEC and different allergy shots. The report stated that her son was supposed to have received an unspecified hepatitis vaccine. On 12-FEB-2007 the patient was feeling achy, weak, tired and nauseous. She also stated that she was not sure that these symptoms were related to the vaccine. Medical attention was sought. The patient was reported as not recovered at the time of this report. Additional information has been requested.


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