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This is VAERS ID 275023

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 275023
Age:77.0
Gender:Male
Location:California
Vaccinated:2007-02-06
Onset:2007-02-06
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1208F / - UN / -
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1476F / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Inappropriate schedule of drug administration, Incorrect drug dosage form administered

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: (therapy unspecified)
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up:Information has been received from a health professional concerning a 77 year old male with no known allergies who on 06-FEB-2007 was vaccinated IM in the right arm with a 1 ml dose of Zostavax (lot # 656412/1476F). The Zostavax was reconstituted with Gar"dasil (lot # 654741/1208F) and the combined product was administered to the patient. It was reported that the patient was on an unspecified concomitant medication. No symptoms have been reported. Unspecified medical attention was sought. There was no prod


Changed on 12/8/2009

VAERS ID: 275023 Before After
Age:77.0
Gender:Male
Location:California
Vaccinated:2007-02-06
Onset:2007-02-06
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1208F / - UN / -
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1476F / - - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Inappropriate schedule of drug administration, Incorrect drug dosage form administered, Incorrect dose administered

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: (therapy unspecified)
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type': (blank) WAES0702USA00873

Write-up:Information has been received from a health professional concerning a 77 year old male with no known allergies who on 06-FEB-2007 was vaccinated IM in the right arm with a 1 ml dose of Zostavax (lot # 656412/1476F). The Zostavax was reconstituted with Gar"dasil Gardasil (lot # 654741/1208F) and the combined product was administered to the patient. It was reported that the patient was on an unspecified concomitant medication. No symptoms have been reported. Unspecified medical attention was sought. There was no prod product quality complaint involved. Additional information has been requested.


Changed on 3/2/2010

VAERS ID: 275023 Before After
Age:77.0
Gender:Male
Location:California
Vaccinated:2007-02-06
Onset:2007-02-06
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1208F / - UN / -
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1476F / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Incorrect drug dosage form administered, Incorrect dose administered

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: (therapy unspecified)
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0702USA00873

Write-up:Information has been received from a health professional concerning a 77 year old male with no known allergies who on 06-FEB-2007 was vaccinated IM in the right arm with a 1 ml dose of Zostavax (lot # 656412/1476F). The Zostavax was reconstituted with Gardasil (lot # 654741/1208F) and the combined product was administered to the patient. It was reported that the patient was on an unspecified concomitant medication. No symptoms have been reported. Unspecified medical attention was sought. There was no product quality complaint involved. Additional information has been requested.


Changed on 4/7/2010

VAERS ID: 275023 Before After
Age:77.0
Gender:Male
Location:California
Vaccinated:2007-02-06
Onset:2007-02-06
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1208F / - UN / -
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1476F / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Incorrect drug dosage form administered, Incorrect dose administered

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: (therapy unspecified)
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0702USA00873

Write-up:Information has been received from a health professional concerning a 77 year old male with no known allergies who on 06-FEB-2007 was vaccinated IM in the right arm with a 1 ml dose of Zostavax (lot # 656412/1476F). The Zostavax was reconstituted with Gardasil (lot # 654741/1208F) and the combined product was administered to the patient. It was reported that the patient was on an unspecified concomitant medication. No symptoms have been reported. Unspecified medical attention was sought. There was no product quality complaint involved. Additional information has been requested.


Changed on 6/14/2014

VAERS ID: 275023 Before After
Age:77.0
Gender:Male
Location:California
Vaccinated:2007-02-06
Onset:2007-02-06
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1208F / - UN / -
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1476F / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Incorrect drug dosage form administered, Incorrect dose administered

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: (therapy unspecified)
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0702USA00873

Write-up:Information has been received from a health professional concerning a 77 year old male with no known allergies who on 06-FEB-2007 was vaccinated IM in the right arm with a 1 ml dose of Zostavax (lot # 656412/1476F). The Zostavax was reconstituted with Gardasil (lot # 654741/1208F) and the combined product was administered to the patient. It was reported that the patient was on an unspecified concomitant medication. No symptoms have been reported. Unspecified medical attention was sought. There was no product quality complaint involved. Additional information has been requested.


Changed on 5/14/2017

VAERS ID: 275023 Before After
Age:77.0
Gender:Male
Location:California
Vaccinated:2007-02-06
Onset:2007-02-06
Submitted:2007-03-14
Entered:2007-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1208F / - UN / -
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. 1476F / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Incorrect drug dosage form administered, Incorrect dose administered

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: (therapy unspecified)
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0702USA00873

Write-up:Information has been received from a health professional concerning a 77 year old male with no known allergies who on 06-FEB-2007 was vaccinated IM in the right arm with a 1 ml dose of Zostavax (lot # 656412/1476F). The Zostavax was reconstituted with Gardasil (lot # 654741/1208F) and the combined product was administered to the patient. It was reported that the patient was on an unspecified concomitant medication. No symptoms have been reported. Unspecified medical attention was sought. There was no product quality complaint involved. Additional information has been requested.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=275023&WAYBACKHISTORY=ON


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