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This is VAERS ID 279218

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

279218
VAERS Form:
Age:15.0
Gender:Female
Location:Unknown
Vaccinated:2007-04-12
Onset:2007-04-13
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / UN

Administered by: Other      Purchased by: Unknown
Symptoms: Asthenia, Breast 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: DEPO-PROVERA INJECTION
Current Illness: Contraception
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up:Information has been received from a health professional concerning a 15 year old female who on 12-APR-2007 was vaccinated with Gardasil. Concomitant therapy included Depo-Provera Injection for birth control. On 13-APR-2007 after receiving her first dose"of the vaccine, the patient experienced soreness in her breasts and weakness. It was reported that the patient received unspecified medical attention. No further information is available. Additional information has been requested.


Changed on 12/8/2009

279218 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Unknown
Vaccinated:2007-04-12
Onset:2007-04-13
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / UN

Administered by: Other      Purchased by: Unknown Other
Symptoms: Asthenia, Breast 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: DEPO-PROVERA INJECTION
Current Illness: Contraception
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': (blank) WAES0704USA02738

Write-up:Information has been received from a health professional concerning a 15 year old female who on 12-APR-2007 was vaccinated with Gardasil. Concomitant therapy included Depo-Provera Injection for birth control. On 13-APR-2007 after receiving her first dose"of dose of the vaccine, the patient experienced soreness in her breasts and weakness. It was reported that the patient received unspecified medical attention. No further information is available. Additional information has been requested.


Changed on 9/14/2017

279218 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:Unknown
Vaccinated:2007-04-12
Onset:2007-04-13
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Breast 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: DEPO-PROVERA INJECTION
Current Illness: Contraception
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0704USA02738

Write-up:Information has been received from a health professional concerning a 15 year old female who on 12-APR-2007 was vaccinated with Gardasil. Concomitant therapy included Depo-Provera Injection for birth control. On 13-APR-2007 after receiving her first dose of the vaccine, the patient experienced soreness in her breasts and weakness. It was reported that the patient received unspecified medical attention. No further information is available. Additional information has been requested.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=279218&WAYBACKHISTORY=ON


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