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This is VAERS ID 279168

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

279168
VAERS Form:
Age:23.0
Gender:Female
Location:New Jersey
Vaccinated:2007-01-19
Onset:2007-01-19
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / 0 - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Inappropriate schedule of drug administration, Injection site erythema, Injection site irritation, Injection site pain

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: ADVAIR
Current Illness: Food allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Pap test -
CDC 'Split Type':

Write-up:Information has been received from a nurse concerning a 23 year old female patient with an unspecified food allergy who on 19-JAN-2007 was vaccinated IM with a first dose of Gardasil lot #654702/0011U. Concomitant therapy included Yasmin and Advair. On 19"-JAN-2007 the patient experienced some irritation around the injection site after the first injection. She reported soreness, burning, erythema at injection site. On 05-APR-2007 patient''''s father (a physician) administered the second dose of Gardasil lot


Changed on 12/8/2009

279168 Before After
VAERS Form:
Age:23.0
Gender:Female
Location:New Jersey
Vaccinated:2007-01-19
Onset:2007-01-19
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / 0 - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Inappropriate schedule of drug administration, Injection site erythema, Injection site irritation, Injection site pain, Smear cervix, 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: ADVAIR
Current Illness: Food allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Pap test -
CDC 'Split Type': (blank) WAES0704USA01198

Write-up:Information has been received from a nurse concerning a 23 year old female patient with an unspecified food allergy who on 19-JAN-2007 was vaccinated IM with a first dose of Gardasil lot #654702/0011U. Concomitant therapy included Yasmin and Advair. On 19"-JAN-2007 19-JAN-2007 the patient experienced some irritation around the injection site after the first injection. She reported soreness, burning, erythema at injection site. On 05-APR-2007 patient''''s patient''s father (a physician) administered the second dose of Gardasil lot #656372/0243U to the patient. Within 24 hours of receiving the second injection she developed hives which covered her entire body. The injection site was red, swollen, and burned. She was prescribed Benadryl. The patient was recovering. Additional information has been requested.


Changed on 9/14/2017

279168 Before After
VAERS Form:(blank) 1
Age:23.0
Gender:Female
Location:New Jersey
Vaccinated:2007-01-19
Onset:2007-01-19
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / 0 1 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Injection site erythema, Injection site irritation, Injection site pain, Smear cervix, 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: ADVAIR
Current Illness: Food allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Pap test -
CDC 'Split Type': WAES0704USA01198

Write-up:Information has been received from a nurse concerning a 23 year old female patient with an unspecified food allergy who on 19-JAN-2007 was vaccinated IM with a first dose of Gardasil lot #654702/0011U. Concomitant therapy included Yasmin and Advair. On 19-JAN-2007 the patient experienced some irritation around the injection site after the first injection. She reported soreness, burning, erythema at injection site. On 05-APR-2007 patient''s father (a physician) administered the second dose of Gardasil lot #656372/0243U to the patient. Within 24 hours of receiving the second injection she developed hives which covered her entire body. The injection site was red, swollen, and burned. She was prescribed Benadryl. The patient was recovering. Additional information has been requested.


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