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This is VAERS ID 275992

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

275992
VAERS Form:
Age:11.0
Gender:Female
Location:Tennessee
Vaccinated:2007-03-04
Onset:0000-00-00
Submitted:2007-04-10
Entered:2007-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / -

Administered by: Other      Purchased by: Unknown
Symptoms: Stevens-Johnson syndrome

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 0     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up:Information has been received from a physician concerning a friend of a friend''''s 11 or 12 year old daughter who on approximately 04-MAR-2007 (/"about 1 month ago/") was vaccinated with a first dose of Gardasil. In approximately March 2007, the patient de"veloped Stevens-Johnson Syndrome and was hospitalized. Her recovery status was unknown at the time of the report. Additional information has been requested.


Changed on 12/8/2009

275992 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:Tennessee
Vaccinated:2007-03-04
Onset:0000-00-00
Submitted:2007-04-10
Entered:2007-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / - UN

Administered by: Other      Purchased by: Unknown Other
Symptoms: Stevens-Johnson syndrome

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 0 (blank)     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': (blank) WAES0704USA00776

Write-up:Information has been received from a physician concerning a friend of a friend''''s friend''s 11 or 12 year old daughter who on approximately 04-MAR-2007 (/"about ("about 1 month ago/") ago") was vaccinated with a first dose of Gardasil. In approximately March 2007, the patient de"veloped developed Stevens-Johnson Syndrome and was hospitalized. Her recovery status was unknown at the time of the report. Additional information has been requested.


Changed on 9/14/2017

275992 Before After
VAERS Form:(blank) 1
Age:11.0
Gender:Female
Location:Tennessee
Vaccinated:2007-03-04
Onset:0000-00-00
Submitted:2007-04-10
Entered:2007-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Stevens-Johnson syndrome

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days:     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0704USA00776

Write-up:Information has been received from a physician concerning a friend of a friend''s 11 or 12 year old daughter who on approximately 04-MAR-2007 ("about 1 month ago") was vaccinated with a first dose of Gardasil. In approximately March 2007, the patient developed Stevens-Johnson Syndrome and was hospitalized. Her recovery status was unknown at the time of the report. Additional information has been requested.


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Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=275992&WAYBACKHISTORY=ON


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