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This is VAERS ID 279192

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

279192
VAERS Form:
Age:19.0
Gender:Female
Location:Texas
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 - / -

Administered by: Other      Purchased by: Unknown
Symptoms: Injection site reaction

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up:Information has been received from a licensed practical nurse concerning a 19 year old female who on an unspecified date was vaccinated with first dose of Gardasil (lot # not reported). The patient sought medical attention. On an unspecified date, the pat"ient developed a /"smallpox like mark/" or skin indentation right below the injection site. At the time of reporting, the outcome was unknown. Additional information has been requested.


Changed on 12/8/2009

279192 Before After
VAERS Form:
Age:19.0
Gender:Female
Location:Texas
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 - UN / - UN

Administered by: Other      Purchased by: Unknown Other
Symptoms: Injection site reaction

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': (blank) WAES0704USA02168

Write-up:Information has been received from a licensed practical nurse concerning a 19 year old female who on an unspecified date was vaccinated with first dose of Gardasil (lot # not reported). The patient sought medical attention. On an unspecified date, the pat"ient patient developed a /"smallpox "smallpox like mark/" mark" or skin indentation right below the injection site. At the time of reporting, the outcome was unknown. Additional information has been requested. Additional information was received. It was reported that they did not give the vaccination. The patient had the "bad experience" elsewhere. Follow up information received stated that on 09-OCT-2007 the patient was administered the second dose of GARDASIL (lot # not provided). The nurse who administered the vaccine reported that when she administered the vaccine some of the vaccine ran down the patienr''s arm. She stated she believed it happened because of technigue and possible tense muscle. No symptoms or probllemms were noted, No additional information is expected.


Changed on 3/2/2010

279192 Before After
VAERS Form:
Age:19.0
Gender:Female
Location:Texas
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / UN IJ

Administered by: Other      Purchased by: Other
Symptoms: Injection site reaction, Skin induration

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0704USA02168

Write-up:Information has been received from a licensed practical nurse concerning a 19 year old female who on an unspecified date was vaccinated with first dose of Gardasil (lot # not reported). The patient sought medical attention. On an unspecified date, the patient developed a "smallpox like mark" or skin indentation right below the injection site. At the time of reporting, the outcome was unknown. Additional information has been requested. Additional information was received. It was reported that they did not give the vaccination. The patient had the "bad experience" elsewhere. Follow up information received stated that on 09-OCT-2007 the patient was administered the second dose of GARDASIL (lot # not provided). The nurse who administered the vaccine reported that when she administered the vaccine some of the vaccine ran down the patienr''s arm. She stated she believed it happened because of technigue and possible tense muscle. No symptoms or probllemms were noted, No additional information is expected.


Changed on 6/14/2014

279192 Before After
VAERS Form:
Age:19.0
Gender:Female
Location:Texas
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / IJ

Administered by: Other      Purchased by: Other
Symptoms: Skin induration

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0704USA02168

Write-up:Information has been received from a licensed practical nurse concerning a 19 year old female who on an unspecified date was vaccinated with first dose of Gardasil (lot # not reported). The patient sought medical attention. On an unspecified date, the patient developed a "smallpox like mark" or skin indentation right below the injection site. At the time of reporting, the outcome was unknown. Additional information has been requested. Additional information was received. It was reported that they did not give the vaccination. The patient had the "bad experience" elsewhere. Follow up information received stated that on 09-OCT-2007 the patient was administered the second dose of GARDASIL (lot # not provided). The nurse who administered the vaccine reported that when she administered the vaccine some of the vaccine ran down the patienr''s arm. She stated she believed it happened because of technigue and possible tense muscle. No symptoms or probllemms were noted, No additional information is expected.


Changed on 5/14/2017

279192 Before After
VAERS Form:
Age:19.0
Gender:Female
Location:Texas
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / IJ

Administered by: Other      Purchased by: Other
Symptoms: Skin induration

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0704USA02168

Write-up:Information has been received from a licensed practical nurse concerning a 19 year old female who on an unspecified date was vaccinated with first dose of Gardasil (lot # not reported). The patient sought medical attention. On an unspecified date, the patient developed a "smallpox like mark" or skin indentation right below the injection site. At the time of reporting, the outcome was unknown. Additional information has been requested. Additional information was received. It was reported that they did not give the vaccination. The patient had the "bad experience" elsewhere. Follow up information received stated that on 09-OCT-2007 the patient was administered the second dose of GARDASIL (lot # not provided). The nurse who administered the vaccine reported that when she administered the vaccine some of the vaccine ran down the patienr''s arm. She stated she believed it happened because of technigue and possible tense muscle. No symptoms or probllemms were noted, No additional information is expected.


Changed on 9/14/2017

279192 Before After
VAERS Form:(blank) 1
Age:19.0
Gender:Female
Location:Texas
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 1 UN / IJ

Administered by: Other      Purchased by: Other
Symptoms: Skin induration

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0704USA02168

Write-up:Information has been received from a licensed practical nurse concerning a 19 year old female who on an unspecified date was vaccinated with first dose of Gardasil (lot # not reported). The patient sought medical attention. On an unspecified date, the patient developed a "smallpox like mark" or skin indentation right below the injection site. At the time of reporting, the outcome was unknown. Additional information has been requested. Additional information was received. It was reported that they did not give the vaccination. The patient had the "bad experience" elsewhere. Follow up information received stated that on 09-OCT-2007 the patient was administered the second dose of GARDASIL (lot # not provided). The nurse who administered the vaccine reported that when she administered the vaccine some of the vaccine ran down the patienr''s arm. She stated she believed it happened because of technigue and possible tense muscle. No symptoms or probllemms were noted, No additional information is expected.


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