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This is VAERS ID 279658

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

279658
VAERS Form:
Age:11.0
Gender:Female
Location:Minnesota
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia

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: (therapy unspecified) (therapy unspecified) (therapy unspecified) (therapy unspecified)
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Information has been received from a company representative and a nurse concerning a 11 year old female who was vaccinated with a 0.5 ml dose of Gardasil. The patient developed a fever and missed at least one day aft school. The interval between administr"ation of the vaccine and the onset of the fever is unknown. The nurse mentioned that the patient also received four additional injections at the same office visit. Subsequently, the patient recovered from the fever. Unspecified medical attention was sough


Changed on 12/8/2009

279658 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:Minnesota
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pyrexia

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: (therapy unspecified) (therapy unspecified) (therapy unspecified) (therapy unspecified)
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': (blank) WAES0705USA00082

Write-up:Information has been received from a company representative and a nurse concerning a 11 year old female who was vaccinated with a 0.5 ml dose of Gardasil. The patient developed a fever and missed at least one day aft school. The interval between administr"ation administration of the vaccine and the onset of the fever is unknown. The nurse mentioned that the patient also received four additional injections at the same office visit. Subsequently, the patient recovered from the fever. Unspecified medical attention was sough sought. Additional information has been requested.


Changed on 3/2/2010

279658 Before After
VAERS Form:
Age:11.0 12.0
Gender:Female
Location:Minnesota
Vaccinated:0000-00-00 2007-04-10
Onset:0000-00-00 2007-04-11
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0001U / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - 0187U / - 0 UN RA / UN IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U1922AB / 0 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2688AA / 0 LA / IM

Administered by: Unknown Private      Purchased by: Unknown Other
Symptoms: Pyrexia

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: (therapy unspecified) (therapy unspecified) (therapy unspecified) (therapy unspecified)
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0705USA00082

Write-up:Information has been received from a company representative and a nurse concerning a 11 year old female who was vaccinated with a 0.5 ml dose of Gardasil. The patient developed a fever and missed at least one day aft school. The interval between administration of the vaccine and the onset of the fever is unknown. The nurse mentioned that the patient also received four additional injections at the same office visit. Subsequently, the patient recovered from the fever. Unspecified medical attention was sought. Additional information has been requested. 07/06/07 This is in follow-up to report(s) previously submitted on 5/14/2007. Information has been received from a nurse and a physician concerning a 12 year old female who had no illness at the time of being vaccinated. On 10-APR-2007, the patient was vaccinated with a first dose of GARDASIL (lot # 656049/0187U) 0.5 ml, IM in the right upper arm. Also on 10-APR-2007, the patient was vaccinated with a first dose of ADACEL (lot # C2688AA) IM in the left upper arm; a first dose of VAQTA (MSD) (lot # 656993/0001U) IM in the right upper arm; and a first dose of MENACTRA (lot # U1922AB) IM in the left upper arm. On 11-APR-2007, at HS, the patient developed a fever for 24 hours. The patient sought medical attention. She also experienced a headache which was not resolved with MOTRIN and missed school on 12-APR-2007. On 13-APR-2007, the patient recovered. No additional information is expected.


Changed on 4/7/2010

279658 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Minnesota
Vaccinated:2007-04-10
Onset:2007-04-11
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0001U / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0187U / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1922AB / 0 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2688AA / 0 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Headache, Pyrexia

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: (therapy unspecified) (therapy unspecified) (therapy unspecified) (therapy unspecified)
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0705USA00082

Write-up:Information has been received from a company representative and a nurse concerning a 11 year old female who was vaccinated with a 0.5 ml dose of Gardasil. The patient developed a fever and missed at least one day aft school. The interval between administration of the vaccine and the onset of the fever is unknown. The nurse mentioned that the patient also received four additional injections at the same office visit. Subsequently, the patient recovered from the fever. Unspecified medical attention was sought. Additional information has been requested. 07/06/07 This is in follow-up to report(s) previously submitted on 5/14/2007. Information has been received from a nurse and a physician concerning a 12 year old female who had no illness at the time of being vaccinated. On 10-APR-2007, the patient was vaccinated with a first dose of GARDASIL (lot # 656049/0187U) 0.5 ml, IM in the right upper arm. Also on 10-APR-2007, the patient was vaccinated with a first dose of ADACEL (lot # C2688AA) IM in the left upper arm; a first dose of VAQTA (MSD) (lot # 656993/0001U) IM in the right upper arm; and a first dose of MENACTRA (lot # U1922AB) IM in the left upper arm. On 11-APR-2007, at HS, the patient developed a fever for 24 hours. The patient sought medical attention. She also experienced a headache which was not resolved with MOTRIN and missed school on 12-APR-2007. On 13-APR-2007, the patient recovered. No additional information is expected.


Changed on 6/14/2014

279658 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Minnesota
Vaccinated:2007-04-10
Onset:2007-04-11
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0001U / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0187U / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1922AB / 0 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2688AA / 0 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Headache, Pyrexia

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: (therapy unspecified) (therapy unspecified) (therapy unspecified) (therapy unspecified)
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0705USA00082

Write-up:Information has been received from a company representative and a nurse concerning a 11 year old female who was vaccinated with a 0.5 ml dose of Gardasil. The patient developed a fever and missed at least one day aft school. The interval between administration of the vaccine and the onset of the fever is unknown. The nurse mentioned that the patient also received four additional injections at the same office visit. Subsequently, the patient recovered from the fever. Unspecified medical attention was sought. Additional information has been requested. 07/06/07 This is in follow-up to report(s) previously submitted on 5/14/2007. Information has been received from a nurse and a physician concerning a 12 year old female who had no illness at the time of being vaccinated. On 10-APR-2007, the patient was vaccinated with a first dose of GARDASIL (lot # 656049/0187U) 0.5 ml, IM in the right upper arm. Also on 10-APR-2007, the patient was vaccinated with a first dose of ADACEL (lot # C2688AA) IM in the left upper arm; a first dose of VAQTA (MSD) (lot # 656993/0001U) IM in the right upper arm; and a first dose of MENACTRA (lot # U1922AB) IM in the left upper arm. On 11-APR-2007, at HS, the patient developed a fever for 24 hours. The patient sought medical attention. She also experienced a headache which was not resolved with MOTRIN and missed school on 12-APR-2007. On 13-APR-2007, the patient recovered. No additional information is expected.


Changed on 5/14/2017

279658 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Minnesota
Vaccinated:2007-04-10
Onset:2007-04-11
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0001U / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0187U / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1922AB / 0 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2688AA / 0 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Headache, Pyrexia

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: (therapy unspecified) (therapy unspecified) (therapy unspecified) (therapy unspecified)
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0705USA00082

Write-up:Information has been received from a company representative and a nurse concerning a 11 year old female who was vaccinated with a 0.5 ml dose of Gardasil. The patient developed a fever and missed at least one day aft school. The interval between administration of the vaccine and the onset of the fever is unknown. The nurse mentioned that the patient also received four additional injections at the same office visit. Subsequently, the patient recovered from the fever. Unspecified medical attention was sought. Additional information has been requested. 07/06/07 This is in follow-up to report(s) previously submitted on 5/14/2007. Information has been received from a nurse and a physician concerning a 12 year old female who had no illness at the time of being vaccinated. On 10-APR-2007, the patient was vaccinated with a first dose of GARDASIL (lot # 656049/0187U) 0.5 ml, IM in the right upper arm. Also on 10-APR-2007, the patient was vaccinated with a first dose of ADACEL (lot # C2688AA) IM in the left upper arm; a first dose of VAQTA (MSD) (lot # 656993/0001U) IM in the right upper arm; and a first dose of MENACTRA (lot # U1922AB) IM in the left upper arm. On 11-APR-2007, at HS, the patient developed a fever for 24 hours. The patient sought medical attention. She also experienced a headache which was not resolved with MOTRIN and missed school on 12-APR-2007. On 13-APR-2007, the patient recovered. No additional information is expected.


Changed on 9/14/2017

279658 Before After
VAERS Form:(blank) 1
Age:12.0
Gender:Female
Location:Minnesota
Vaccinated:2007-04-10
Onset:2007-04-11
Submitted:2007-05-14
Entered:2007-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0001U / 0 1 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0187U / 0 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1922AB / 0 1 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2688AA / 0 1 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Headache, Pyrexia

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: (therapy unspecified) (therapy unspecified) (therapy unspecified) (therapy unspecified)
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0705USA00082

Write-up:Information has been received from a company representative and a nurse concerning a 11 year old female who was vaccinated with a 0.5 ml dose of Gardasil. The patient developed a fever and missed at least one day aft school. The interval between administration of the vaccine and the onset of the fever is unknown. The nurse mentioned that the patient also received four additional injections at the same office visit. Subsequently, the patient recovered from the fever. Unspecified medical attention was sought. Additional information has been requested. 07/06/07 This is in follow-up to report(s) previously submitted on 5/14/2007. Information has been received from a nurse and a physician concerning a 12 year old female who had no illness at the time of being vaccinated. On 10-APR-2007, the patient was vaccinated with a first dose of GARDASIL (lot # 656049/0187U) 0.5 ml, IM in the right upper arm. Also on 10-APR-2007, the patient was vaccinated with a first dose of ADACEL (lot # C2688AA) IM in the left upper arm; a first dose of VAQTA (MSD) (lot # 656993/0001U) IM in the right upper arm; and a first dose of MENACTRA (lot # U1922AB) IM in the left upper arm. On 11-APR-2007, at HS, the patient developed a fever for 24 hours. The patient sought medical attention. She also experienced a headache which was not resolved with MOTRIN and missed school on 12-APR-2007. On 13-APR-2007, the patient recovered. No additional information is expected.


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