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This is VAERS ID 279220

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

279220
VAERS Form:
Age:18.0
Gender:Female
Location:Unknown
Vaccinated:2007-04-11
Onset:2007-04-11
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0187U / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: 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:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up:Information has been received from a Medical Assistant (M.A.) concerning an 18 year old female patient who on 04-NOV-2007 was vaccinated in deltoid with a dose of Gardasil lot #656049/0187U. Concomitant therapy included Depo-Provera in the other arm. The"patient developed hives about four hours after receiving Gardasil. Benadryl was ordered. The patient''''s outcome was unknown. Additional information has been requested.


Changed on 12/8/2009

279220 Before After
VAERS Form:
Age:18.0
Gender:Female
Location:Unknown
Vaccinated:2007-04-11
Onset:2007-04-11
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0187U / - - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: 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:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': (blank) WAES0704USA02838

Write-up:Information has been received from a Medical Assistant (M.A.) concerning an 18 year old female patient who on 04-NOV-2007 was vaccinated in deltoid with a dose of Gardasil lot #656049/0187U. Concomitant therapy included Depo-Provera in the other arm. The"patient The patient developed hives about four hours after receiving Gardasil. Benadryl was ordered. The patient''''s patient''s outcome was unknown. Additional information has been requested.


Changed on 9/14/2017

279220 Before After
VAERS Form:(blank) 1
Age:18.0
Gender:Female
Location:Unknown
Vaccinated:2007-04-11
Onset:2007-04-11
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0187U / - UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: 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:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0704USA02838

Write-up:Information has been received from a Medical Assistant (M.A.) concerning an 18 year old female patient who on 04-NOV-2007 was vaccinated in deltoid with a dose of Gardasil lot #656049/0187U. Concomitant therapy included Depo-Provera in the other arm. The patient developed hives about four hours after receiving Gardasil. Benadryl was ordered. The patient''s outcome was unknown. Additional information has been requested.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=279220&WAYBACKHISTORY=ON


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