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This is VAERS ID 276830

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

276830
VAERS Form:
Age:11.0
Gender:Female
Location:Maryland
Vaccinated:2007-03-14
Onset:2007-03-14
Submitted:2007-04-13
Entered:2007-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Headache, Malaise

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Physical examination 03/16/07 - normal
CDC 'Split Type':

Write-up:Information has been received from a physician concerning a 11 year old female patient with chronic allergies who on 14-MAR-2007 was vaccinated IM with a dose of Gardasil. lot # 655849/0263U. Later that day she developed a headache between her eyes and ma"laise. On 16-MAR-2007 patient had a physical examination which was normal. Her symptoms did not resolve until 18-MAR-2007. Additional information has been requested.


Changed on 12/8/2009

276830 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:Maryland
Vaccinated:2007-03-14
Onset:2007-03-14
Submitted:2007-04-13
Entered:2007-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / - - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Headache, Malaise

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Physical examination 03/16/07 - normal
CDC 'Split Type': (blank) WAES0703USA03793

Write-up:Information has been received from a physician concerning a 11 year old female patient with chronic allergies who on 14-MAR-2007 was vaccinated IM with a dose of Gardasil. lot # 655849/0263U. Later that day she developed a headache between her eyes and ma"laise. malaise. On 16-MAR-2007 patient had a physical examination which was normal. Her symptoms did not resolve until 18-MAR-2007. Additional information has been requested.


Changed on 3/2/2010

276830 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:Maryland
Vaccinated:2007-03-14
Onset:2007-03-14
Submitted:2007-04-13
Entered:2007-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / - - / IM

Administered by: Other Private      Purchased by: Other
Symptoms: Headache, Malaise

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Physical examination 03/16/07 - normal
CDC 'Split Type': WAES0703USA03793

Write-up:Information has been received from a physician concerning a 11 year old female patient with chronic allergies seasonal allergies, allergic rhinitis, obesity and possible attention deficit disorder who on 14-MAR-2007 14-MAR-2007, at 5:00 PM was vaccinated IM with a dose of Gardasil. lot # 655849/0263U. Later that day she developed a headache between her eyes and malaise. In folllow up it was reported that on 14-MAR-2007 patient developed headaches, eye pain and mild malaise at 6:00 PM. On 16-MAR-2007 15-MAR-2007 patient had a physical examination which was normal. Her symptoms did completely resolved within a few days. On 16-MAR-2007 patient recoverd. Addititional information is not resolve until 18-MAR-2007. Additional information has been requested. expected.


Changed on 4/7/2010

276830 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:Maryland
Vaccinated:2007-03-14
Onset:2007-03-14
Submitted:2007-04-13
Entered:2007-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / - - / IM

Administered by: Private      Purchased by: Other
Symptoms: Eye pain, Headache, Malaise

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Physical examination 03/16/07 - normal
CDC 'Split Type': WAES0703USA03793

Write-up:Information has been received from a physician concerning a 11 year old female patient with chronic seasonal allergies, allergic rhinitis, obesity and possible attention deficit disorder who on 14-MAR-2007, at 5:00 PM was vaccinated IM with a dose of Gardasil. lot # 655849/0263U. Later that day she developed a headache between her eyes and malaise. In folllow up it was reported that on 14-MAR-2007 patient developed headaches, eye pain and mild malaise at 6:00 PM. On 15-MAR-2007 patient had a physical examination which was normal. Her symptoms completely resolved within a few days. On 16-MAR-2007 patient recoverd. Addititional information is not expected.


Changed on 6/14/2014

276830 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:Maryland
Vaccinated:2007-03-14
Onset:2007-03-14
Submitted:2007-04-13
Entered:2007-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / - - / IM

Administered by: Private      Purchased by: Other
Symptoms: Eye pain, Headache, Malaise

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Physical examination 03/16/07 - normal
CDC 'Split Type': WAES0703USA03793

Write-up:Information has been received from a physician concerning a 11 year old female patient with chronic seasonal allergies, allergic rhinitis, obesity and possible attention deficit disorder who on 14-MAR-2007, at 5:00 PM was vaccinated IM with a dose of Gardasil. lot # 655849/0263U. Later that day she developed a headache between her eyes and malaise. In folllow up it was reported that on 14-MAR-2007 patient developed headaches, eye pain and mild malaise at 6:00 PM. On 15-MAR-2007 patient had a physical examination which was normal. Her symptoms completely resolved within a few days. On 16-MAR-2007 patient recoverd. Addititional information is not expected.


Changed on 5/14/2017

276830 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:Maryland
Vaccinated:2007-03-14
Onset:2007-03-14
Submitted:2007-04-13
Entered:2007-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / - - / IM

Administered by: Private      Purchased by: Other
Symptoms: Eye pain, Headache, Malaise

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Physical examination 03/16/07 - normal
CDC 'Split Type': WAES0703USA03793

Write-up:Information has been received from a physician concerning a 11 year old female patient with chronic seasonal allergies, allergic rhinitis, obesity and possible attention deficit disorder who on 14-MAR-2007, at 5:00 PM was vaccinated IM with a dose of Gardasil. lot # 655849/0263U. Later that day she developed a headache between her eyes and malaise. In folllow up it was reported that on 14-MAR-2007 patient developed headaches, eye pain and mild malaise at 6:00 PM. On 15-MAR-2007 patient had a physical examination which was normal. Her symptoms completely resolved within a few days. On 16-MAR-2007 patient recoverd. Addititional information is not expected.


Changed on 9/14/2017

276830 Before After
VAERS Form:(blank) 1
Age:11.0
Gender:Female
Location:Maryland
Vaccinated:2007-03-14
Onset:2007-03-14
Submitted:2007-04-13
Entered:2007-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / - UNK - / IM

Administered by: Private      Purchased by: Other
Symptoms: Eye pain, Headache, Malaise

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Physical examination 03/16/07 - normal
CDC 'Split Type': WAES0703USA03793

Write-up:Information has been received from a physician concerning a 11 year old female patient with chronic seasonal allergies, allergic rhinitis, obesity and possible attention deficit disorder who on 14-MAR-2007, at 5:00 PM was vaccinated IM with a dose of Gardasil. lot # 655849/0263U. Later that day she developed a headache between her eyes and malaise. In folllow up it was reported that on 14-MAR-2007 patient developed headaches, eye pain and mild malaise at 6:00 PM. On 15-MAR-2007 patient had a physical examination which was normal. Her symptoms completely resolved within a few days. On 16-MAR-2007 patient recoverd. Addititional information is not expected.


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