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This is VAERS ID 279634

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

279634
VAERS Form:
Age:23.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-02
Onset:2007-04-02
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0188U / 2 - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Injection site mass

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: Drug hypersensitivity, allergic reaction to antibiotics
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up:Information has been received from a health care worker concerning a 23 year old female with drug reactions to /"emytin/" and Cipro who on 02-APR-2007 was vaccinated intramuscularly with a third dose of Gardasil (Lot # 657006/0188U). On 02-APR-2007 the pa"tient developed a lump on her right arm after administration of the vaccine. The patient sought unspecified medical attention. At the time of this report, the patient''''s lump on her right arm persisted. No product quality complaint was involved. Additiona


Changed on 12/8/2009

279634 Before After
VAERS Form:
Age:23.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-02
Onset:2007-04-02
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0188U / 2 - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Injection site mass

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: Drug hypersensitivity, allergic reaction to antibiotics
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': (blank) WAES0704USA06246

Write-up:Information has been received from a health care worker concerning a 23 year old female with drug reactions to /"emytin/" "emytin" and Cipro who on 02-APR-2007 was vaccinated intramuscularly with a third dose of Gardasil (Lot # 657006/0188U). On 02-APR-2007 the pa"tient patient developed a lump on her right arm after administration of the vaccine. The patient sought unspecified medical attention. At the time of this report, the patient''''s patient''s lump on her right arm persisted. No product quality complaint was involved. Additiona Additional information has been requested.


Changed on 9/14/2017

279634 Before After
VAERS Form:(blank) 1
Age:23.0
Gender:Female
Location:Pennsylvania
Vaccinated:2007-04-02
Onset:2007-04-02
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0188U / 2 3 - / IM

Administered by: Other      Purchased by: Other
Symptoms: Injection site mass

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: Drug hypersensitivity, allergic reaction to antibiotics
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0704USA06246

Write-up:Information has been received from a health care worker concerning a 23 year old female with drug reactions to "emytin" and Cipro who on 02-APR-2007 was vaccinated intramuscularly with a third dose of Gardasil (Lot # 657006/0188U). On 02-APR-2007 the patient developed a lump on her right arm after administration of the vaccine. The patient sought unspecified medical attention. At the time of this report, the patient''s lump on her right arm persisted. No product quality complaint was involved. Additional information has been requested.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=279634&WAYBACKHISTORY=ON


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