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This is VAERS ID 275559

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 275559
VAERS Form:
Age:12.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-03-26
Onset:2007-03-27
Submitted:2007-04-03
Entered:2007-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0186U / 0 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B009AA / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Rash papular

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:
Current Illness: none
Preexisting Conditions: nickel and lactose allergies
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: patient developed a skin collored papular nonpruritic rash on arms and face 5 days after receiving hpv and tdap vaccines. came to the doctors to be evalauted for the rash. no other symptoms or sequelae


Changed on 12/8/2009

VAERS ID: 275559 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-03-26
Onset:2007-03-27
Submitted:2007-04-03
Entered:2007-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0186U / 0 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B009AA / 0 LA / IM

Administered by: Private      Purchased by: Unknown Public
Symptoms: Rash papular

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:
Current Illness: none
Preexisting Conditions: nickel and lactose allergies
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: patient developed a skin collored papular nonpruritic rash on arms and face 5 days after receiving hpv and tdap vaccines. came to the doctors to be evalauted for the rash. no other symptoms or sequelae


Changed on 9/14/2017

VAERS ID: 275559 Before After
VAERS Form:(blank) 1
Age:12.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-03-26
Onset:2007-03-27
Submitted:2007-04-03
Entered:2007-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0186U / 0 1 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B009AA / 0 1 LA / IM

Administered by: Private      Purchased by: Public
Symptoms: Rash papular

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:
Current Illness: none
Preexisting Conditions: nickel and lactose allergies
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: patient developed a skin collored papular nonpruritic rash on arms and face 5 days after receiving hpv and tdap vaccines. came to the doctors to be evalauted for the rash. no other symptoms or sequelae


Changed on 2/14/2018

VAERS ID: 275559 Before After
VAERS Form:1
Age:12.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-03-26
Onset:2007-03-27
Submitted:2007-04-03
Entered:2007-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0186U / 1 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B009AA / 1 LA / IM

Administered by: Private      Purchased by: Public
Symptoms: Rash papular

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:
Current Illness: none
Preexisting Conditions: nickel and lactose allergies
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: patient developed a skin collored papular nonpruritic rash on arms and face 5 days after receiving hpv and tdap vaccines. came to the doctors to be evalauted for the rash. no other symptoms or sequelae


Changed on 6/14/2018

VAERS ID: 275559 Before After
VAERS Form:1
Age:12.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-03-26
Onset:2007-03-27
Submitted:2007-04-03
Entered:2007-04-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0186U / 1 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B009AA / 1 LA / IM

Administered by: Private      Purchased by: Public
Symptoms: Rash papular

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:
Current Illness: none
Preexisting Conditions: nickel and lactose allergies
Allergies:
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: patient developed a skin collored papular nonpruritic rash on arms and face 5 days after receiving hpv and tdap vaccines. came to the doctors to be evalauted for the rash. no other symptoms or sequelae

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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=275559&WAYBACKHISTORY=ON


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