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This is VAERS ID 283783

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

283783
VAERS Form:
Age:17.0
Gender:Female
Location:Washington
Vaccinated:2007-04-02
Onset:2007-05-04
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / 1 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Skin lesion

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: Ortho Tri-Cyclen; Effexor
Current Illness: Penicillin allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES0705USA01517

Write-up:Information has been received from a nurse practitioner concerning a 17 year old female with allergies to penicillin and amoxicillin who on 02-APR-2007 was vaccinated IM with a second dose of 0.5 ml of Gardasil (Lot # 654702/0011U). Concomitant therapy included EFFEXOR and ORTHO TRI-CYCLEN. On 04-MAY-2007 the patient developed lesions, which manifested as circular with white spots, on her hands and at the achilles tendon of the feet after she received the second dose of Gardasil. Additional information has been requested.


Changed on 3/2/2010

283783 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Washington
Vaccinated:2007-04-02
Onset:2007-05-04 2007-04-21
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / 1 UN / IM

Administered by: Other Private      Purchased by: Other Private
Symptoms: Skin lesion

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: Ortho Tri-Cyclen; Effexor
Current Illness: Penicillin allergy
Preexisting Conditions: Penicillin allergy
Allergies:
Diagnostic Lab Data: Rapid plasma reagin card, negative
CDC 'Split Type': WAES0705USA01517

Write-up:Information has been received from a nurse practitioner concerning a 17 year old female with allergies to penicillin and amoxicillin who on 02-APR-2007 was vaccinated IM with a second dose of 0.5 ml of Gardasil (Lot # 654702/0011U). Concomitant therapy included EFFEXOR and ORTHO TRI-CYCLEN. On 04-MAY-2007 21-APR-2007, the patient experienced an itchy throat without respiratory distress, but did not seek medical attention. On 01-MAY-2007, the patient was seen by the nurse practitioner who described the circular lesions. 04-MAY-2007, the patient developed lesions, which manifested as circular with white spots, on her hands and at the achilles tendon of the feet after she received the second dose of Gardasil. Gardasil No fever was noted. The "target" appearance resolved in three days. On an unspecified date, a rapid plasma reagin card test was performed, the result of which was negative. The patient outcome was unknown. Additional information has been requested. Additional infromation is not expected.


Changed on 4/7/2010

283783 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Washington
Vaccinated:2007-04-02
Onset:2007-04-21
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / 1 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Skin lesion, Throat irritation, Treponema test negative

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: Ortho Tri-Cyclen; Effexor
Current Illness: Penicillin allergy
Preexisting Conditions: Penicillin allergy
Allergies:
Diagnostic Lab Data: Rapid plasma reagin card, negative
CDC 'Split Type': WAES0705USA01517

Write-up:Information has been received from a nurse practitioner concerning a 17 year old female with allergies to penicillin and amoxicillin who on 02-APR-2007 was vaccinated IM with a second dose of 0.5 ml of Gardasil (Lot # 654702/0011U). Concomitant therapy included EFFEXOR and ORTHO TRI-CYCLEN. On 21-APR-2007, the patient experienced an itchy throat without respiratory distress, but did not seek medical attention. On 01-MAY-2007, the patient was seen by the nurse practitioner who described the circular lesions. 04-MAY-2007, the patient developed lesions, which manifested as circular with white spots, on her hands and at the achilles tendon of the feet after she received the second dose of Gardasil No fever was noted. The "target" appearance resolved in three days. On an unspecified date, a rapid plasma reagin card test was performed, the result of which was negative. The patient outcome was unknown. Additional information has been requested. Additional infromation is not expected.


Changed on 8/31/2010

283783 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Washington
Vaccinated:2007-04-02
Onset:2007-04-21
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / 1 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Skin lesion, Throat irritation, Syphilis test negative, Treponema test negative

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: Ortho Tri-Cyclen; Effexor
Current Illness: Penicillin allergy
Preexisting Conditions: Penicillin allergy
Allergies:
Diagnostic Lab Data: Rapid plasma reagin card, negative
CDC 'Split Type': WAES0705USA01517

Write-up:Information has been received from a nurse practitioner concerning a 17 year old female with allergies to penicillin and amoxicillin who on 02-APR-2007 was vaccinated IM with a second dose of 0.5 ml of Gardasil (Lot # 654702/0011U). Concomitant therapy included EFFEXOR and ORTHO TRI-CYCLEN. On 21-APR-2007, the patient experienced an itchy throat without respiratory distress, but did not seek medical attention. On 01-MAY-2007, the patient was seen by the nurse practitioner who described the circular lesions. 04-MAY-2007, the patient developed lesions, which manifested as circular with white spots, on her hands and at the achilles tendon of the feet after she received the second dose of Gardasil No fever was noted. The "target" appearance resolved in three days. On an unspecified date, a rapid plasma reagin card test was performed, the result of which was negative. The patient outcome was unknown. Additional information has been requested. Additional infromation is not expected.


Changed on 1/4/2011

283783 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Washington
Vaccinated:2007-04-02
Onset:2007-04-21
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / 1 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Skin lesion, Throat irritation, Syphilis test negative, Treponema test negative

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: Ortho Tri-Cyclen; Effexor
Current Illness: Penicillin allergy
Preexisting Conditions: Penicillin allergy
Allergies:
Diagnostic Lab Data: Rapid plasma reagin card, negative
CDC 'Split Type': WAES0705USA01517

Write-up:Information has been received from a nurse practitioner concerning a 17 year old female with allergies to penicillin and amoxicillin who on 02-APR-2007 was vaccinated IM with a second dose of 0.5 ml of Gardasil (Lot # 654702/0011U). Concomitant therapy included EFFEXOR and ORTHO TRI-CYCLEN. On 21-APR-2007, the patient experienced an itchy throat without respiratory distress, but did not seek medical attention. On 01-MAY-2007, the patient was seen by the nurse practitioner who described the circular lesions. 04-MAY-2007, the patient developed lesions, which manifested as circular with white spots, on her hands and at the achilles tendon of the feet after she received the second dose of Gardasil No fever was noted. The "target" appearance resolved in three days. On an unspecified date, a rapid plasma reagin card test was performed, the result of which was negative. The patient outcome was unknown. Additional information has been requested. Additional infromation is not expected.


Changed on 6/14/2014

283783 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Washington
Vaccinated:2007-04-02
Onset:2007-04-21
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / 1 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Skin lesion, Throat irritation, Treponema test negative

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: Ortho Tri-Cyclen; Effexor
Current Illness: Penicillin allergy
Preexisting Conditions: Penicillin allergy
Allergies:
Diagnostic Lab Data: Rapid plasma reagin card, negative
CDC 'Split Type': WAES0705USA01517

Write-up:Information has been received from a nurse practitioner concerning a 17 year old female with allergies to penicillin and amoxicillin who on 02-APR-2007 was vaccinated IM with a second dose of 0.5 ml of Gardasil (Lot # 654702/0011U). Concomitant therapy included EFFEXOR and ORTHO TRI-CYCLEN. On 21-APR-2007, the patient experienced an itchy throat without respiratory distress, but did not seek medical attention. On 01-MAY-2007, the patient was seen by the nurse practitioner who described the circular lesions. 04-MAY-2007, the patient developed lesions, which manifested as circular with white spots, on her hands and at the achilles tendon of the feet after she received the second dose of Gardasil No fever was noted. The "target" appearance resolved in three days. On an unspecified date, a rapid plasma reagin card test was performed, the result of which was negative. The patient outcome was unknown. Additional information has been requested. Additional infromation is not expected.


Changed on 5/14/2017

283783 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Washington
Vaccinated:2007-04-02
Onset:2007-04-21
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / 1 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Skin lesion, Throat irritation, Treponema test negative

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: Ortho Tri-Cyclen; Effexor
Current Illness: Penicillin allergy
Preexisting Conditions: Penicillin allergy
Allergies:
Diagnostic Lab Data: Rapid plasma reagin card, negative
CDC 'Split Type': WAES0705USA01517

Write-up:Information has been received from a nurse practitioner concerning a 17 year old female with allergies to penicillin and amoxicillin who on 02-APR-2007 was vaccinated IM with a second dose of 0.5 ml of Gardasil (Lot # 654702/0011U). Concomitant therapy included EFFEXOR and ORTHO TRI-CYCLEN. On 21-APR-2007, the patient experienced an itchy throat without respiratory distress, but did not seek medical attention. On 01-MAY-2007, the patient was seen by the nurse practitioner who described the circular lesions. 04-MAY-2007, the patient developed lesions, which manifested as circular with white spots, on her hands and at the achilles tendon of the feet after she received the second dose of Gardasil No fever was noted. The "target" appearance resolved in three days. On an unspecified date, a rapid plasma reagin card test was performed, the result of which was negative. The patient outcome was unknown. Additional information has been requested. Additional infromation is not expected.


Changed on 9/14/2017

283783 Before After
VAERS Form:(blank) 1
Age:17.0
Gender:Female
Location:Washington
Vaccinated:2007-04-02
Onset:2007-04-21
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / 1 2 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Skin lesion, Throat irritation, Treponema test negative

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: Ortho Tri-Cyclen; Effexor
Current Illness: Penicillin allergy
Preexisting Conditions: Penicillin allergy
Allergies:
Diagnostic Lab Data: Rapid plasma reagin card, negative
CDC 'Split Type': WAES0705USA01517

Write-up:Information has been received from a nurse practitioner concerning a 17 year old female with allergies to penicillin and amoxicillin who on 02-APR-2007 was vaccinated IM with a second dose of 0.5 ml of Gardasil (Lot # 654702/0011U). Concomitant therapy included EFFEXOR and ORTHO TRI-CYCLEN. On 21-APR-2007, the patient experienced an itchy throat without respiratory distress, but did not seek medical attention. On 01-MAY-2007, the patient was seen by the nurse practitioner who described the circular lesions. 04-MAY-2007, the patient developed lesions, which manifested as circular with white spots, on her hands and at the achilles tendon of the feet after she received the second dose of Gardasil No fever was noted. The "target" appearance resolved in three days. On an unspecified date, a rapid plasma reagin card test was performed, the result of which was negative. The patient outcome was unknown. Additional information has been requested. Additional infromation is not expected.


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