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This is VAERS ID 283791

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

283791
VAERS Form:
Age:17.0
Gender:Female
Location:New York
Vaccinated:2007-01-15
Onset:2007-01-15
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1447F / 0 LA / UN

Administered by: Private      Purchased by: Other
Symptoms: Dizziness, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Penicillin allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0705USA01682

Write-up:Information has been received from a physician''s assistant concerning a 17 year old white female (132 lbs, 5''4") with an amoxicillin allergy who on 15-JAN-2007 was vaccinated by a nurse with Gardasil, lot # 655617/1447F in the left arm. On 15-JAN-2007 the patient experienced severe dizziness and arm pain for 2 days. On 18-JAN-2007 the patient recovered. No treatment was sought. Additional information has been requested.


Changed on 3/2/2010

283791 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:New York
Vaccinated:2007-01-15
Onset:2007-01-15
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1447F / 0 LA / UN

Administered by: Private      Purchased by: Other
Symptoms: Dizziness, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Penicillin allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0705USA01682

Write-up:Information has been received from a physician''s assistant concerning a 17 year old white female (132 lbs, 5''4") with an amoxicillin allergy who on 15-JAN-2007 was vaccinated by a nurse with Gardasil, lot # 655617/1447F in the left arm. On 15-JAN-2007 the patient experienced severe dizziness and arm pain for 2 days. On 18-JAN-2007 the patient recovered. No treatment was sought. Additional information has been requested. Initial and follow up information has been received frm a physician''s assistant concerning a 17 year old female with an AMOXICILLN allergy who on 15-JAN-2007 was vaccinated by a nurse with GARDASIL, lot # 655617/1447F in the left upper arm. The patient had no known illnesses at the time of vaccination. On 15-JAN-2007 the patient experinced severe dizziness and arm pain for 2 days. On 18-JAN-2007 the patient recovered.


Changed on 6/14/2014

283791 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:New York
Vaccinated:2007-01-15
Onset:2007-01-15
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1447F / 0 LA / UN

Administered by: Private      Purchased by: Other
Symptoms: Dizziness, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Penicillin allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0705USA01682

Write-up:Information has been received from a physician''s assistant concerning a 17 year old white female (132 lbs, 5''4") with an amoxicillin allergy who on 15-JAN-2007 was vaccinated by a nurse with Gardasil, lot # 655617/1447F in the left arm. On 15-JAN-2007 the patient experienced severe dizziness and arm pain for 2 days. On 18-JAN-2007 the patient recovered. No treatment was sought. Additional information has been requested. Initial and follow up information has been received frm a physician''s assistant concerning a 17 year old female with an AMOXICILLN allergy who on 15-JAN-2007 was vaccinated by a nurse with GARDASIL, lot # 655617/1447F in the left upper arm. The patient had no known illnesses at the time of vaccination. On 15-JAN-2007 the patient experinced severe dizziness and arm pain for 2 days. On 18-JAN-2007 the patient recovered.


Changed on 5/14/2017

283791 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:New York
Vaccinated:2007-01-15
Onset:2007-01-15
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1447F / 0 LA / UN

Administered by: Private      Purchased by: Other
Symptoms: Dizziness, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Penicillin allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0705USA01682

Write-up:Information has been received from a physician''s assistant concerning a 17 year old white female (132 lbs, 5''4") with an amoxicillin allergy who on 15-JAN-2007 was vaccinated by a nurse with Gardasil, lot # 655617/1447F in the left arm. On 15-JAN-2007 the patient experienced severe dizziness and arm pain for 2 days. On 18-JAN-2007 the patient recovered. No treatment was sought. Additional information has been requested. Initial and follow up information has been received frm a physician''s assistant concerning a 17 year old female with an AMOXICILLN allergy who on 15-JAN-2007 was vaccinated by a nurse with GARDASIL, lot # 655617/1447F in the left upper arm. The patient had no known illnesses at the time of vaccination. On 15-JAN-2007 the patient experinced severe dizziness and arm pain for 2 days. On 18-JAN-2007 the patient recovered.


Changed on 9/14/2017

283791 Before After
VAERS Form:(blank) 1
Age:17.0
Gender:Female
Location:New York
Vaccinated:2007-01-15
Onset:2007-01-15
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1447F / 0 1 LA / UN

Administered by: Private      Purchased by: Other
Symptoms: Dizziness, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Penicillin allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0705USA01682

Write-up:Information has been received from a physician''s assistant concerning a 17 year old white female (132 lbs, 5''4") with an amoxicillin allergy who on 15-JAN-2007 was vaccinated by a nurse with Gardasil, lot # 655617/1447F in the left arm. On 15-JAN-2007 the patient experienced severe dizziness and arm pain for 2 days. On 18-JAN-2007 the patient recovered. No treatment was sought. Additional information has been requested. Initial and follow up information has been received frm a physician''s assistant concerning a 17 year old female with an AMOXICILLN allergy who on 15-JAN-2007 was vaccinated by a nurse with GARDASIL, lot # 655617/1447F in the left upper arm. The patient had no known illnesses at the time of vaccination. On 15-JAN-2007 the patient experinced severe dizziness and arm pain for 2 days. On 18-JAN-2007 the patient recovered.


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