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This is VAERS ID 279521

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

279521
VAERS Form:
Age:17.0
Gender:Female
Location:Arizona
Vaccinated:2007-04-17
Onset:2007-04-18
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0384U / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Erythema, Injection site rash, Pyrexia, Rash, Urticaria

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

Write-up:Initial and follow up information has been received from a nurse practitioner (NP)/ certified nurse midwife, and a nurse, concerning a 17 year old caucasionr female patient, who on 17-APR-2007, at 3:30pm was vaccinated IM in the left deltoid with the firs"t dose of Gardasil (Lot #657617/0384U). Concomitant therapy included Yasmin. There was no known illness at the time of vaccination. The nurse practitioner reported that 18-APR-2007, (previously reported by the nurse as on the same day, 17-APR-2007), the p


Changed on 12/8/2009

279521 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Arizona
Vaccinated:2007-04-17
Onset:2007-04-18
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0384U / 0 LA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Erythema, Injection site rash, Pyrexia, Rash, Urticaria

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: YASMIN
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': (blank) WAES0704USA04634

Write-up:Initial and follow up information has been received from a nurse practitioner (NP)/ certified nurse midwife, and a nurse, concerning a 17 year old caucasionr female patient, who on 17-APR-2007, at 3:30pm was vaccinated IM in the left deltoid with the firs"t first dose of Gardasil (Lot #657617/0384U). Concomitant therapy included Yasmin. There was no known illness at the time of vaccination. The nurse practitioner reported that 18-APR-2007, (previously reported by the nurse as on the same day, 17-APR-2007), the p patient developed a rash on the left arm (the arm of injection), which later spread to both arms; the rash was described as "redness with urticarial raised patches." The nurse added that the patient also developed a fever. At the time of this report, the NP confirmed that the patient had recovered from the rash and fever (date unspecified). The patient sought unspecified medical attention. No further information is expected. Additional information has been requested.


Changed on 9/14/2017

279521 Before After
VAERS Form:(blank) 1
Age:17.0
Gender:Female
Location:Arizona
Vaccinated:2007-04-17
Onset:2007-04-18
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0384U / 0 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Erythema, Injection site rash, Pyrexia, Rash, Urticaria

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: YASMIN
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0704USA04634

Write-up:Initial and follow up information has been received from a nurse practitioner (NP)/ certified nurse midwife, and a nurse, concerning a 17 year old caucasionr female patient, who on 17-APR-2007, at 3:30pm was vaccinated IM in the left deltoid with the first dose of Gardasil (Lot #657617/0384U). Concomitant therapy included Yasmin. There was no known illness at the time of vaccination. The nurse practitioner reported that 18-APR-2007, (previously reported by the nurse as on the same day, 17-APR-2007), the patient developed a rash on the left arm (the arm of injection), which later spread to both arms; the rash was described as "redness with urticarial raised patches." The nurse added that the patient also developed a fever. At the time of this report, the NP confirmed that the patient had recovered from the rash and fever (date unspecified). The patient sought unspecified medical attention. No further information is expected. Additional information has been requested.


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