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This is VAERS ID 276128

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 276128
VAERS Form:
Age:20.0
Gender:Female
Location:Illinois
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-04-06
Entered:2007-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Herpes zoster

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? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Information has been received from a pharmacist concerning a 20 year old female with pertinent medical history not reported and drug reactions/allergies reported as none who on an unspecified date was vaccinated with HPV rL1 6 11 18 VLP vaccine (yeast), 0".5 ml, IM. Concomitant medication was not reported. Approximately on week after vaccination, the patient reported that she experienced shingles. The outcome and causality of the event was not reported. Additional information has been requested.


Changed on 12/8/2009

VAERS ID: 276128 Before After
VAERS Form:
Age:20.0
Gender:Female
Location:Illinois
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-04-06
Entered:2007-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Herpes zoster

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? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) WAES0703USA00447

Write-up: Information has been received from a pharmacist concerning a 20 year old female with pertinent medical history not reported and drug reactions/allergies reported as none who on an unspecified date was vaccinated with HPV rL1 6 11 18 VLP vaccine (yeast), 0".5 0.5 ml, IM. Concomitant medication was not reported. Approximately on week after vaccination, the patient reported that she experienced shingles. The outcome and causality of the event was not reported. Additional information has been requested.


Changed on 9/14/2017

VAERS ID: 276128 Before After
VAERS Form:(blank) 1
Age:20.0
Gender:Female
Location:Illinois
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-04-06
Entered:2007-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Herpes zoster

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? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES0703USA00447

Write-up: Information has been received from a pharmacist concerning a 20 year old female with pertinent medical history not reported and drug reactions/allergies reported as none who on an unspecified date was vaccinated with HPV rL1 6 11 18 VLP vaccine (yeast), 0.5 ml, IM. Concomitant medication was not reported. Approximately on week after vaccination, the patient reported that she experienced shingles. The outcome and causality of the event was not reported. Additional information has been requested.


Changed on 2/14/2018

VAERS ID: 276128 Before After
VAERS Form:1
Age:20.0
Gender:Female
Location:Illinois
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-04-06
Entered:2007-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Herpes zoster

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? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES0703USA00447

Write-up: Information has been received from a pharmacist concerning a 20 year old female with pertinent medical history not reported and drug reactions/allergies reported as none who on an unspecified date was vaccinated with HPV rL1 6 11 18 VLP vaccine (yeast), 0.5 ml, IM. Concomitant medication was not reported. Approximately on week after vaccination, the patient reported that she experienced shingles. The outcome and causality of the event was not reported. Additional information has been requested.


Changed on 6/14/2018

VAERS ID: 276128 Before After
VAERS Form:1
Age:20.0
Gender:Female
Location:Illinois
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-04-06
Entered:2007-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Herpes zoster

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? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES0703USA00447

Write-up: Information has been received from a pharmacist concerning a 20 year old female with pertinent medical history not reported and drug reactions/allergies reported as none who on an unspecified date was vaccinated with HPV rL1 6 11 18 VLP vaccine (yeast), 0.5 ml, IM. Concomitant medication was not reported. Approximately on week after vaccination, the patient reported that she experienced shingles. The outcome and causality of the event was not reported. Additional information has been requested.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=276128&WAYBACKHISTORY=ON


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