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This is VAERS ID 279173

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 279173
Age:20.0
Gender:Female
Location:Minnesota
Vaccinated:2007-01-03
Onset:2007-01-03
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / UN
TTOX: TETANUS TOXOID (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Other      Purchased by: Unknown
Symptoms: Pain in extremity

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up:Information has been received from a Registered Nurse (R.N.) concerning her 20 year old daughter who on 03-JAN-2007 was vaccinated with a first dose 0.5 mL of Gardasil. Concomitant therapy included influenza virus vaccine (unspecified) and tetanus toxoid"given in opposite arm where the Gardasil was given. On 03-JAN-2007 the patient experienced pain in the arm (which arm unknown) after receiving the first injection. As of 09-APR-2007 the patient had not received the second dose of Gardasil. Unspecified med


Changed on 12/8/2009

VAERS ID: 279173 Before After
Age:20.0
Gender:Female
Location:Minnesota
Vaccinated:2007-01-03
Onset:2007-01-03
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (NO BRAND NAME) INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / UN
TTOX: TETANUS TOXOID (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Other      Purchased by: Unknown Other
Symptoms: Pain in extremity

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type': (blank) WAES0704USA01334

Write-up:Information has been received from a Registered Nurse (R.N.) concerning her 20 year old daughter who on 03-JAN-2007 was vaccinated with a first dose 0.5 mL of Gardasil. Concomitant therapy included influenza virus vaccine (unspecified) and tetanus toxoid"given toxoid given in opposite arm where the Gardasil was given. On 03-JAN-2007 the patient experienced pain in the arm (which arm unknown) after receiving the first injection. As of 09-APR-2007 the patient had not received the second dose of Gardasil. Unspecified med medical attention was sought. On 04-JAN-2007 the patient recovered. Additional information has been requested.


Changed on 7/7/2013

VAERS ID: 279173 Before After
Age:20.0
Gender:Female
Location:Minnesota
Vaccinated:2007-01-03
Onset:2007-01-03
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / UN
TTOX: TETANUS TOXOID (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Pain in extremity

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0704USA01334

Write-up:Information has been received from a Registered Nurse (R.N.) concerning her 20 year old daughter who on 03-JAN-2007 was vaccinated with a first dose 0.5 mL of Gardasil. Concomitant therapy included influenza virus vaccine (unspecified) and tetanus toxoid given in opposite arm where the Gardasil was given. On 03-JAN-2007 the patient experienced pain in the arm (which arm unknown) after receiving the first injection. As of 09-APR-2007 the patient had not received the second dose of Gardasil. Unspecified medical attention was sought. On 04-JAN-2007 the patient recovered. Additional information has been requested.


Changed on 12/14/2016

VAERS ID: 279173 Before After
Age:20.0
Gender:Female
Location:Minnesota
Vaccinated:2007-01-03
Onset:2007-01-03
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / UN
TTOX: TETANUS TOXOID (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Pain in extremity

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0704USA01334

Write-up:Information has been received from a Registered Nurse (R.N.) concerning her 20 year old daughter who on 03-JAN-2007 was vaccinated with a first dose 0.5 mL of Gardasil. Concomitant therapy included influenza virus vaccine (unspecified) and tetanus toxoid given in opposite arm where the Gardasil was given. On 03-JAN-2007 the patient experienced pain in the arm (which arm unknown) after receiving the first injection. As of 09-APR-2007 the patient had not received the second dose of Gardasil. Unspecified medical attention was sought. On 04-JAN-2007 the patient recovered. Additional information has been requested.


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