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This is VAERS ID 279063

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

279063
VAERS Form:
Age:18.0
Gender:Female
Location:Unknown
Vaccinated:2007-01-11
Onset:2007-01-18
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Rash, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: dicloxacillin
Current Illness:
Preexisting Conditions: Unk
Allergies:
Diagnostic Lab Data: Unk
CDC 'Split Type':

Write-up:Information has been received from a physician (allergist) concerning a female between 18 to 20 years old who on 11-JAN-2007 was vaccinated with first dose of Gardasil. Concomitant therapy included dicloxacillin from 04-JAN-2007 to 14-JAN-2007. On 28-JAN-"2007, the patient developed a hives rash over her arms and legs when administered the vaccine. The patient sought unspecified medical attention. Additional information has been requested.


Changed on 12/8/2009

279063 Before After
VAERS Form:
Age:18.0
Gender:Female
Location:Unknown
Vaccinated:2007-01-11
Onset:2007-01-18
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Rash, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: dicloxacillin
Current Illness:
Preexisting Conditions: Unk
Allergies:
Diagnostic Lab Data: Unk
CDC 'Split Type': (blank) WAES0704USA00770

Write-up:Information has been received from a physician (allergist) concerning a female between 18 to 20 years old who on 11-JAN-2007 was vaccinated with first dose of Gardasil. Concomitant therapy included dicloxacillin from 04-JAN-2007 to 14-JAN-2007. On 28-JAN-"2007, 28-JAN-2007, the patient developed a hives rash over her arms and legs when administered the vaccine. The patient sought unspecified medical attention. Additional information has been requested.


Changed on 9/14/2017

279063 Before After
VAERS Form:(blank) 1
Age:18.0
Gender:Female
Location:Unknown
Vaccinated:2007-01-11
Onset:2007-01-18
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 1 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Rash, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: dicloxacillin
Current Illness:
Preexisting Conditions: Unk
Allergies:
Diagnostic Lab Data: Unk
CDC 'Split Type': WAES0704USA00770

Write-up:Information has been received from a physician (allergist) concerning a female between 18 to 20 years old who on 11-JAN-2007 was vaccinated with first dose of Gardasil. Concomitant therapy included dicloxacillin from 04-JAN-2007 to 14-JAN-2007. On 28-JAN-2007, the patient developed a hives rash over her arms and legs when administered the vaccine. The patient sought unspecified medical attention. Additional information has been requested.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=279063&WAYBACKHISTORY=ON


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