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This is VAERS ID 276127

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

276127
VAERS Form:
Age:22.0
Gender:Female
Location:Indiana
Vaccinated:2007-01-12
Onset:2007-01-12
Submitted:2007-04-06
Entered:2007-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0697F / 0 - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Body temperature increased, Pyrexia

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: Depo-Provera
Current Illness:
Preexisting Conditions: Allergic reaction to antibiotics
Allergies:
Diagnostic Lab Data: body temp 01/12/07 102
CDC 'Split Type':

Write-up:Information has been received from a registered nurse concerning a 22 year old female with an allergy to tetracycline who on 12-JAN-2007 was vaccinated IM with a 0.5 mL first dose of Gardasil (Lot# 653650/0697F). Concomitant therapy included medroxyproges"terone acetate (DEPO-PROVERA). On 12-JAN-2007 the patient developed a 102 degree fever later that evening. Subsequently, the patient recovered. Additional information has been requested.


Changed on 12/8/2009

276127 Before After
VAERS Form:
Age:22.0
Gender:Female
Location:Indiana
Vaccinated:2007-01-12
Onset:2007-01-12
Submitted:2007-04-06
Entered:2007-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0697F / 0 - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Body temperature increased, Pyrexia

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: Depo-Provera
Current Illness:
Preexisting Conditions: Allergic reaction to antibiotics
Allergies:
Diagnostic Lab Data: body temp 01/12/07 102
CDC 'Split Type': (blank) WAES0703USA00443

Write-up:Information has been received from a registered nurse concerning a 22 year old female with an allergy to tetracycline who on 12-JAN-2007 was vaccinated IM with a 0.5 mL first dose of Gardasil (Lot# 653650/0697F). Concomitant therapy included medroxyproges"terone medroxyprogesterone acetate (DEPO-PROVERA). On 12-JAN-2007 the patient developed a 102 degree fever later that evening. Subsequently, the patient recovered. Additional information has been requested.


Changed on 3/2/2010

276127 Before After
VAERS Form:
Age:22.0
Gender:Female
Location:Indiana
Vaccinated:2007-01-12
Onset:2007-01-12
Submitted:2007-04-06
Entered:2007-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0697F / 0 - LA / IM

Administered by: Other Private      Purchased by: Other Private
Symptoms: Body temperature increased, Pyrexia

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: Depo-Provera Depo-Provera; ALLEGRA
Current Illness: Allergic reaction to antibiotics; Drug hypersensitivity
Preexisting Conditions: Allergic reaction to antibiotics
Allergies:
Diagnostic Lab Data: body temp 01/12/07 temp, 01/12/07, 102
CDC 'Split Type': WAES0703USA00443

Write-up:Information This is in follow-up to reports(s) previously submitted on 4/6/2007. Initial and follow-up information has been received from a registered nurse concerning a 22 year old female with an allergy allergies to tetracycline tetracycline, VICODIN and TRAMADOL who on 12-JAN-2007 at 1:45 PM, was vaccinated IM into the left arm with a 0.5 mL first dose of Gardasil GARDASIL (Lot# 653650/0697F). There was no illness at the time of vaccination. Concomitant therapy included medroxyprogesterone acetate (DEPO-PROVERA). (DEPO-PROVERA) and ALLEGRA. On 12-JAN-2007 13-JAN-2007 the patient developed called complaining of a fever that started on the day of the injection at 8:00PM. The fever was about 102 degree fever later that evening. degrees. Subsequently, the patient recovered. recovered and there were no other problems reported. Additional information has been requested. is not expected.


Changed on 6/14/2014

276127 Before After
VAERS Form:
Age:22.0
Gender:Female
Location:Indiana
Vaccinated:2007-01-12
Onset:2007-01-12
Submitted:2007-04-06
Entered:2007-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0697F / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Body temperature increased, Pyrexia

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: Depo-Provera; ALLEGRA
Current Illness: Allergic reaction to antibiotics; Drug hypersensitivity
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: body temp, 01/12/07, 102
CDC 'Split Type': WAES0703USA00443

Write-up:This is in follow-up to reports(s) previously submitted on 4/6/2007. Initial and follow-up information has been received from a registered nurse concerning a 22 year old female with allergies to tetracycline, VICODIN and TRAMADOL who on 12-JAN-2007 at 1:45 PM, was vaccinated IM into the left arm with a 0.5 mL first dose of GARDASIL (Lot# 653650/0697F). There was no illness at the time of vaccination. Concomitant therapy included medroxyprogesterone acetate (DEPO-PROVERA) and ALLEGRA. On 13-JAN-2007 the patient called complaining of a fever that started on the day of the injection at 8:00PM. The fever was about 102 degrees. Subsequently, the patient recovered and there were no other problems reported. Additional information is not expected.


Changed on 5/14/2017

276127 Before After
VAERS Form:
Age:22.0
Gender:Female
Location:Indiana
Vaccinated:2007-01-12
Onset:2007-01-12
Submitted:2007-04-06
Entered:2007-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0697F / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Body temperature increased, Pyrexia

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: Depo-Provera; ALLEGRA
Current Illness: Allergic reaction to antibiotics; Drug hypersensitivity
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: body temp, 01/12/07, 102
CDC 'Split Type': WAES0703USA00443

Write-up:This is in follow-up to reports(s) previously submitted on 4/6/2007. Initial and follow-up information has been received from a registered nurse concerning a 22 year old female with allergies to tetracycline, VICODIN and TRAMADOL who on 12-JAN-2007 at 1:45 PM, was vaccinated IM into the left arm with a 0.5 mL first dose of GARDASIL (Lot# 653650/0697F). There was no illness at the time of vaccination. Concomitant therapy included medroxyprogesterone acetate (DEPO-PROVERA) and ALLEGRA. On 13-JAN-2007 the patient called complaining of a fever that started on the day of the injection at 8:00PM. The fever was about 102 degrees. Subsequently, the patient recovered and there were no other problems reported. Additional information is not expected.


Changed on 9/14/2017

276127 Before After
VAERS Form:(blank) 1
Age:22.0
Gender:Female
Location:Indiana
Vaccinated:2007-01-12
Onset:2007-01-12
Submitted:2007-04-06
Entered:2007-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0697F / 0 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Body temperature increased, Pyrexia

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: Depo-Provera; ALLEGRA
Current Illness: Allergic reaction to antibiotics; Drug hypersensitivity
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: body temp, 01/12/07, 102
CDC 'Split Type': WAES0703USA00443

Write-up:This is in follow-up to reports(s) previously submitted on 4/6/2007. Initial and follow-up information has been received from a registered nurse concerning a 22 year old female with allergies to tetracycline, VICODIN and TRAMADOL who on 12-JAN-2007 at 1:45 PM, was vaccinated IM into the left arm with a 0.5 mL first dose of GARDASIL (Lot# 653650/0697F). There was no illness at the time of vaccination. Concomitant therapy included medroxyprogesterone acetate (DEPO-PROVERA) and ALLEGRA. On 13-JAN-2007 the patient called complaining of a fever that started on the day of the injection at 8:00PM. The fever was about 102 degrees. Subsequently, the patient recovered and there were no other problems reported. Additional information is not expected.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=276127&WAYBACKHISTORY=ON


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