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This is VAERS ID 279501

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

279501
VAERS Form:
Age:13.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-01
Onset:2007-04-01
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Rash

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: Eczema
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up:Information has been received from a physician concerning a 13 year old female with a history of eczema who in April 2007, was vaccinated with Gardasil. In April 2007, within 24 hours later after receiving the vaccine, the patient experienced a rash behin"d her knee. It was reported that the patient sought unspecified medical attention. No further information was provided. Additional information has been requested.


Changed on 12/8/2009

279501 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-01
Onset:2007-04-01
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Rash

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: Eczema
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': (blank) WAES0704USA04279

Write-up:Information has been received from a physician concerning a 13 year old female with a history of eczema who in April 2007, was vaccinated with Gardasil. In April 2007, within 24 hours later after receiving the vaccine, the patient experienced a rash behin"d behind her knee. It was reported that the patient sought unspecified medical attention. No further information was provided. Additional information has been requested.


Changed on 3/2/2010

279501 Before After
VAERS Form:
Age:13.0 17.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-01 2007-03-28
Onset:2007-04-01 2007-04-03
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - 0188U / - 0 - LA / IM

Administered by: Other Private      Purchased by: Other Private
Symptoms: Rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Yes
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: Eczema
Allergies:
Diagnostic Lab Data: Unknown None
CDC 'Split Type': WAES0704USA04279

Write-up:Information has been received from a physician concerning a 13 year old female with a history of eczema who in April 2007, was vaccinated with Gardasil. In April 2007, within 24 hours later after receiving the vaccine, the patient experienced a rash behind her knee. It was reported that the patient sought unspecified medical attention. No further information was provided. Additional information has been requested. 10/08/07 This is in follow-up to report(s) previously submitted on 5/14/2007. Initial and follow-up information has been received from a physician concerning a 17 year old female with a history of eczema who on 28-MAR-2007 at 10:45 am was vaccinated intramuscularly into the left deltoid with the first dose of the GARDASIL (Lot # 657006/0188U). On approximately 03-APR-2007, within 24 hours after receiving the vaccine (also reported as one week after vaccination), the patient developed an eczema-like rash behind her knee. It was reported that the patient sought unspecified medical attention. There were no laboratory or diagnostic tests performed. The patient recovered on an unspecified date. This is a consolidation of two reports. Additional information is not expected.


Changed on 6/14/2014

279501 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-03-28
Onset:2007-04-03
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0188U / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Eczema
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type': WAES0704USA04279

Write-up:Information has been received from a physician concerning a 13 year old female with a history of eczema who in April 2007, was vaccinated with Gardasil. In April 2007, within 24 hours later after receiving the vaccine, the patient experienced a rash behind her knee. It was reported that the patient sought unspecified medical attention. No further information was provided. Additional information has been requested. 10/08/07 This is in follow-up to report(s) previously submitted on 5/14/2007. Initial and follow-up information has been received from a physician concerning a 17 year old female with a history of eczema who on 28-MAR-2007 at 10:45 am was vaccinated intramuscularly into the left deltoid with the first dose of the GARDASIL (Lot # 657006/0188U). On approximately 03-APR-2007, within 24 hours after receiving the vaccine (also reported as one week after vaccination), the patient developed an eczema-like rash behind her knee. It was reported that the patient sought unspecified medical attention. There were no laboratory or diagnostic tests performed. The patient recovered on an unspecified date. This is a consolidation of two reports. Additional information is not expected.


Changed on 5/14/2017

279501 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-03-28
Onset:2007-04-03
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0188U / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Eczema
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type': WAES0704USA04279

Write-up:Information has been received from a physician concerning a 13 year old female with a history of eczema who in April 2007, was vaccinated with Gardasil. In April 2007, within 24 hours later after receiving the vaccine, the patient experienced a rash behind her knee. It was reported that the patient sought unspecified medical attention. No further information was provided. Additional information has been requested. 10/08/07 This is in follow-up to report(s) previously submitted on 5/14/2007. Initial and follow-up information has been received from a physician concerning a 17 year old female with a history of eczema who on 28-MAR-2007 at 10:45 am was vaccinated intramuscularly into the left deltoid with the first dose of the GARDASIL (Lot # 657006/0188U). On approximately 03-APR-2007, within 24 hours after receiving the vaccine (also reported as one week after vaccination), the patient developed an eczema-like rash behind her knee. It was reported that the patient sought unspecified medical attention. There were no laboratory or diagnostic tests performed. The patient recovered on an unspecified date. This is a consolidation of two reports. Additional information is not expected.


Changed on 9/14/2017

279501 Before After
VAERS Form:(blank) 1
Age:17.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-03-28
Onset:2007-04-03
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0188U / 0 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Eczema
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type': WAES0704USA04279

Write-up:Information has been received from a physician concerning a 13 year old female with a history of eczema who in April 2007, was vaccinated with Gardasil. In April 2007, within 24 hours later after receiving the vaccine, the patient experienced a rash behind her knee. It was reported that the patient sought unspecified medical attention. No further information was provided. Additional information has been requested. 10/08/07 This is in follow-up to report(s) previously submitted on 5/14/2007. Initial and follow-up information has been received from a physician concerning a 17 year old female with a history of eczema who on 28-MAR-2007 at 10:45 am was vaccinated intramuscularly into the left deltoid with the first dose of the GARDASIL (Lot # 657006/0188U). On approximately 03-APR-2007, within 24 hours after receiving the vaccine (also reported as one week after vaccination), the patient developed an eczema-like rash behind her knee. It was reported that the patient sought unspecified medical attention. There were no laboratory or diagnostic tests performed. The patient recovered on an unspecified date. This is a consolidation of two reports. Additional information is not expected.


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