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This is VAERS ID 279656

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

279656
VAERS Form:
Age:17.0
Gender:Female
Location:New York
Vaccinated:2007-04-26
Onset:2007-04-26
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0387U / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cough, Epistaxis, Pain, Pharyngolaryngeal pain

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

Write-up:Information has been received from a company representative and a nurse concerning a 17 year old female patient who on 26-APR-2007 was vaccinated with Gardasil (lot # 657621/0387U). On 26-APR-2007 the patient experienced body ache, cough, sore throat and"a nose bleed. The nurse reported the following: The patient did not go to dance class that night which is unlike her. On 27-APR-2007, the patient went to ''''Six Flags:/" and only went on one ride which is unlike her. The patient did nothing over the weeken


Changed on 12/8/2009

279656 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:New York
Vaccinated:2007-04-26
Onset:2007-04-26
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0387U / - - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cough, Epistaxis, Pain, Pharyngolaryngeal pain

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: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) WAES0705USA00076

Write-up:Information has been received from a company representative and a nurse concerning a 17 year old female patient who on 26-APR-2007 was vaccinated with Gardasil (lot # 657621/0387U). On 26-APR-2007 the patient experienced body ache, cough, sore throat and"a and a nose bleed. The nurse reported the following: The patient did not go to dance class that night which is unlike her. On 27-APR-2007, the patient went to ''''Six Flags:/" ''Six Flags:" and only went on one ride which is unlike her. The patient did nothing over the weeken weekend. The patient had 3 nose bleeds that started on 29-APR-2007 and the 3rd nose bleed lasted from 1:15 am on 30-APR-2007. The patient did not go to school on 30-APR-2007. The patient will see her primary care physician for follow-up. The patient was not recovered at the time of the report. Additional information has been requested.


Changed on 9/14/2017

279656 Before After
VAERS Form:(blank) 1
Age:17.0
Gender:Female
Location:New York
Vaccinated:2007-04-26
Onset:2007-04-26
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0387U / - UNK - / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cough, Epistaxis, Pain, Pharyngolaryngeal pain

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: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES0705USA00076

Write-up:Information has been received from a company representative and a nurse concerning a 17 year old female patient who on 26-APR-2007 was vaccinated with Gardasil (lot # 657621/0387U). On 26-APR-2007 the patient experienced body ache, cough, sore throat and a nose bleed. The nurse reported the following: The patient did not go to dance class that night which is unlike her. On 27-APR-2007, the patient went to ''Six Flags:" and only went on one ride which is unlike her. The patient did nothing over the weekend. The patient had 3 nose bleeds that started on 29-APR-2007 and the 3rd nose bleed lasted from 1:15 am on 30-APR-2007. The patient did not go to school on 30-APR-2007. The patient will see her primary care physician for follow-up. The patient was not recovered at the time of the report. Additional information has been requested.


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