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This is VAERS ID 283798

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

283798
VAERS Form:
Age:13.0
Gender:Female
Location:Unknown
Vaccinated:2007-04-20
Onset:2007-04-20
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Breast cyst

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: Unknown
CDC 'Split Type': WAES0705USA01871

Write-up:Information has been received from a certified medical assistant concerning a 13 year old female who on 20-APR-2007 was vaccinated with the second Gardasil (date of first vaccine not reported). Subsequently, the patient developed three fluid-filled cysts in her breast. The cysts were then drained. The results of the drainage and the patient''s outcome were not reported. Additional information has been requested.


Changed on 3/2/2010

283798 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Unknown Alabama
Vaccinated:2007-04-20
Onset:2007-04-20
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - 0955F / 1 0 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Breast cyst

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No 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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown Ultrasound, breast- results not reported; Aspiration (procedure), breast- results not reported
CDC 'Split Type': WAES0705USA01871

Write-up:This is in follow-up to report(s) previously submitted on 6/10/2007. Information has been received from a certified medical assistant concerning a 13 year old female who on 20-APR-2007 11-OCT-2006 was vaccinated in the right deltoid with a first dose of GARDASIL (lot 653978/0955F). On 20-APR-2007, the patient was vaccinated in the right deltoid with the second Gardasil (date (lot 657617/0384U). The patient had no illness at the time of first vaccine not reported). vaccination. Subsequently, the patient developed three fluid-filled cysts in her breast. The cysts were then drained. The results of the drainage and the patient''s outcome were not reported. Additional The patient subsequently recovered. No additional information has been requested. is expected.


Changed on 4/7/2010

283798 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Alabama
Vaccinated:2007-04-20
Onset:2007-04-20
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 0 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Breast cyst, Ultrasound scan

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Ultrasound, breast- results not reported; Aspiration (procedure), breast- results not reported
CDC 'Split Type': WAES0705USA01871

Write-up:This is in follow-up to report(s) previously submitted on 6/10/2007. Information has been received from a certified medical assistant concerning a 13 year old female who on 11-OCT-2006 was vaccinated in the right deltoid with a first dose of GARDASIL (lot 653978/0955F). On 20-APR-2007, the patient was vaccinated in the right deltoid with the second Gardasil (lot 657617/0384U). The patient had no illness at the time of vaccination. Subsequently, the patient developed three fluid-filled cysts in her breast. The cysts were then drained. The results of the drainage and the patient''s outcome were not reported. The patient subsequently recovered. No additional information is expected.


Changed on 8/31/2010

283798 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Alabama
Vaccinated:2007-04-20
Onset:2007-04-20
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 0 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Breast cyst, Ultrasound scan

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Ultrasound, breast- results not reported; Aspiration (procedure), breast- results not reported
CDC 'Split Type': WAES0705USA01871

Write-up:This is in follow-up to report(s) previously submitted on 6/10/2007. Information has been received from a certified medical assistant concerning a 13 year old female who on 11-OCT-2006 was vaccinated in the right deltoid with a first dose of GARDASIL (lot 653978/0955F). On 20-APR-2007, the patient was vaccinated in the right deltoid with the second Gardasil (lot 657617/0384U). The patient had no illness at the time of vaccination. Subsequently, the patient developed three fluid-filled cysts in her breast. The cysts were then drained. The results of the drainage and the patient''s outcome were not reported. The patient subsequently recovered. No additional information is expected.


Changed on 1/4/2011

283798 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Alabama
Vaccinated:2007-04-20
Onset:2007-04-20
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 0 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Breast cyst, Ultrasound scan

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Ultrasound, breast- results not reported; Aspiration (procedure), breast- results not reported
CDC 'Split Type': WAES0705USA01871

Write-up:This is in follow-up to report(s) previously submitted on 6/10/2007. Information has been received from a certified medical assistant concerning a 13 year old female who on 11-OCT-2006 was vaccinated in the right deltoid with a first dose of GARDASIL (lot 653978/0955F). On 20-APR-2007, the patient was vaccinated in the right deltoid with the second Gardasil (lot 657617/0384U). The patient had no illness at the time of vaccination. Subsequently, the patient developed three fluid-filled cysts in her breast. The cysts were then drained. The results of the drainage and the patient''s outcome were not reported. The patient subsequently recovered. No additional information is expected.


Changed on 4/13/2011

283798 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Alabama
Vaccinated:2007-04-20
Onset:2007-04-20
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 0 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Breast cyst, Ultrasound scan

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Ultrasound, breast- results not reported; Aspiration (procedure), breast- results not reported
CDC 'Split Type': WAES0705USA01871

Write-up:This is in follow-up to report(s) previously submitted on 6/10/2007. Information has been received from a certified medical assistant concerning a 13 year old female who on 11-OCT-2006 was vaccinated in the right deltoid with a first dose of GARDASIL (lot 653978/0955F). On 20-APR-2007, the patient was vaccinated in the right deltoid with the second Gardasil (lot 657617/0384U). The patient had no illness at the time of vaccination. Subsequently, the patient developed three fluid-filled cysts in her breast. The cysts were then drained. The results of the drainage and the patient''s outcome were not reported. The patient subsequently recovered. No additional information is expected.


Changed on 5/13/2011

283798 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Alabama
Vaccinated:2007-04-20
Onset:2007-04-20
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 0 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Breast cyst, Ultrasound scan

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Ultrasound, breast- results not reported; Aspiration (procedure), breast- results not reported
CDC 'Split Type': WAES0705USA01871

Write-up:This is in follow-up to report(s) previously submitted on 6/10/2007. Information has been received from a certified medical assistant concerning a 13 year old female who on 11-OCT-2006 was vaccinated in the right deltoid with a first dose of GARDASIL (lot 653978/0955F). On 20-APR-2007, the patient was vaccinated in the right deltoid with the second Gardasil (lot 657617/0384U). The patient had no illness at the time of vaccination. Subsequently, the patient developed three fluid-filled cysts in her breast. The cysts were then drained. The results of the drainage and the patient''s outcome were not reported. The patient subsequently recovered. No additional information is expected.


Changed on 6/11/2011

283798 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Alabama
Vaccinated:2007-04-20
Onset:2007-04-20
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 0 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Breast cyst, Ultrasound scan

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Ultrasound, breast- results not reported; Aspiration (procedure), breast- results not reported
CDC 'Split Type': WAES0705USA01871

Write-up:This is in follow-up to report(s) previously submitted on 6/10/2007. Information has been received from a certified medical assistant concerning a 13 year old female who on 11-OCT-2006 was vaccinated in the right deltoid with a first dose of GARDASIL (lot 653978/0955F). On 20-APR-2007, the patient was vaccinated in the right deltoid with the second Gardasil (lot 657617/0384U). The patient had no illness at the time of vaccination. Subsequently, the patient developed three fluid-filled cysts in her breast. The cysts were then drained. The results of the drainage and the patient''s outcome were not reported. The patient subsequently recovered. No additional information is expected.


Changed on 6/14/2014

283798 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Alabama
Vaccinated:2007-04-20
Onset:2007-04-20
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 0 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Breast cyst, Ultrasound scan

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Ultrasound, breast- results not reported; Aspiration (procedure), breast- results not reported
CDC 'Split Type': WAES0705USA01871

Write-up:This is in follow-up to report(s) previously submitted on 6/10/2007. Information has been received from a certified medical assistant concerning a 13 year old female who on 11-OCT-2006 was vaccinated in the right deltoid with a first dose of GARDASIL (lot 653978/0955F). On 20-APR-2007, the patient was vaccinated in the right deltoid with the second Gardasil (lot 657617/0384U). The patient had no illness at the time of vaccination. Subsequently, the patient developed three fluid-filled cysts in her breast. The cysts were then drained. The results of the drainage and the patient''s outcome were not reported. The patient subsequently recovered. No additional information is expected.


Changed on 5/14/2017

283798 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Alabama
Vaccinated:2007-04-20
Onset:2007-04-20
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 0 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Breast cyst, Ultrasound scan

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Ultrasound, breast- results not reported; Aspiration (procedure), breast- results not reported
CDC 'Split Type': WAES0705USA01871

Write-up:This is in follow-up to report(s) previously submitted on 6/10/2007. Information has been received from a certified medical assistant concerning a 13 year old female who on 11-OCT-2006 was vaccinated in the right deltoid with a first dose of GARDASIL (lot 653978/0955F). On 20-APR-2007, the patient was vaccinated in the right deltoid with the second Gardasil (lot 657617/0384U). The patient had no illness at the time of vaccination. Subsequently, the patient developed three fluid-filled cysts in her breast. The cysts were then drained. The results of the drainage and the patient''s outcome were not reported. The patient subsequently recovered. No additional information is expected.


Changed on 9/14/2017

283798 Before After
VAERS Form:(blank) 1
Age:13.0
Gender:Female
Location:Alabama
Vaccinated:2007-04-20
Onset:2007-04-20
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / 0 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Breast cyst

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Ultrasound, breast- results not reported; Aspiration (procedure), breast- results not reported
CDC 'Split Type': WAES0705USA01871

Write-up:This is in follow-up to report(s) previously submitted on 6/10/2007. Information has been received from a certified medical assistant concerning a 13 year old female who on 11-OCT-2006 was vaccinated in the right deltoid with a first dose of GARDASIL (lot 653978/0955F). On 20-APR-2007, the patient was vaccinated in the right deltoid with the second Gardasil (lot 657617/0384U). The patient had no illness at the time of vaccination. Subsequently, the patient developed three fluid-filled cysts in her breast. The cysts were then drained. The results of the drainage and the patient''s outcome were not reported. The patient subsequently recovered. No additional information is expected.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=283798&WAYBACKHISTORY=ON


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