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This is VAERS ID 279511

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

279511
VAERS Form:
Age:11.0
Gender:Female
Location:Unknown
Vaccinated:2007-04-12
Onset:2007-04-16
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Urticaria, Varicella, Exposure to communicable disease

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

Write-up:Information has been received from a nurse practitioner (NP), via a company representative, concerning an 11 year old female who on 12-APR-2007 was vaccinated with the second dose Gardasil. Concomitant therapy included Boostrix. On 16-APR-2007 the patient"experienced intermittent hives that look like tiny pimples that are not itchy. The event persisted as of 20-APR-2007. Follow up information from the NP, via the company representative, confirmed that the patient''''s hives/rash was /"diagnosed as a case of


Changed on 12/8/2009

279511 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:Unknown
Vaccinated:2007-04-12
Onset:2007-04-16
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Urticaria, Varicella, Exposure to communicable disease

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: BOOSTRIX
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': (blank) WAES0704USA04485

Write-up:Information has been received from a nurse practitioner (NP), via a company representative, concerning an 11 year old female who on 12-APR-2007 was vaccinated with the second dose Gardasil. Concomitant therapy included Boostrix. On 16-APR-2007 the patient"experienced patient experienced intermittent hives that look like tiny pimples that are not itchy. The event persisted as of 20-APR-2007. Follow up information from the NP, via the company representative, confirmed that the patient''''s patient''s hives/rash was /"diagnosed "diagnosed as a case of chicken pox." The NP stated that there was an outbreak in the patient''s school district. At the time of this report, the patient had not recovered from the chicken pox. The patient sought unspecified medical attention. Additional information has been requested.


Changed on 9/14/2017

279511 Before After
VAERS Form:(blank) 1
Age:11.0
Gender:Female
Location:Unknown
Vaccinated:2007-04-12
Onset:2007-04-16
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 2 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Urticaria, Varicella, Exposure to communicable disease

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: BOOSTRIX
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0704USA04485

Write-up:Information has been received from a nurse practitioner (NP), via a company representative, concerning an 11 year old female who on 12-APR-2007 was vaccinated with the second dose Gardasil. Concomitant therapy included Boostrix. On 16-APR-2007 the patient experienced intermittent hives that look like tiny pimples that are not itchy. The event persisted as of 20-APR-2007. Follow up information from the NP, via the company representative, confirmed that the patient''s hives/rash was "diagnosed as a case of chicken pox." The NP stated that there was an outbreak in the patient''s school district. At the time of this report, the patient had not recovered from the chicken pox. The patient sought unspecified medical attention. Additional information has been requested.


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