National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 283939

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

283939
VAERS Form:
Age:19.0
Gender:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:2007-02-15
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: Biopsy skin, Vasculitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: YASMIN
Current Illness: Drug hypersensitivity
Preexisting Conditions: Viral myocarditis
Allergies:
Diagnostic Lab Data: Biopsy ?/?/07 - confirmed subcutaneous vasculitis
CDC 'Split Type': WAES0705USA02268

Write-up:Information has been received from a physician concerning a 19 year old female with a BACTRIM allergy and a history of viral myocarditis (approximately 2005) who has had doses of Gardasil. Concomitant therapy included YASMIN. On 15-FEB-2007 the patient experienced subcutaneous vasculitis. A biopsy was performed which confirmed the subcutaneous vasculitis. The physician noted the two dosed of vaccine were administered at another facility so she did not have the dated of administration or the lot numbers. The patient''s subcutaneous vasculitis persisted. Additional information has been requested.


Changed on 9/14/2017

283939 Before After
VAERS Form:(blank) 1
Age:19.0
Gender:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:2007-02-15
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Biopsy skin, Vasculitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: YASMIN
Current Illness: Drug hypersensitivity
Preexisting Conditions: Viral myocarditis
Allergies:
Diagnostic Lab Data: Biopsy ?/?/07 - confirmed subcutaneous vasculitis
CDC 'Split Type': WAES0705USA02268

Write-up:Information has been received from a physician concerning a 19 year old female with a BACTRIM allergy and a history of viral myocarditis (approximately 2005) who has had doses of Gardasil. Concomitant therapy included YASMIN. On 15-FEB-2007 the patient experienced subcutaneous vasculitis. A biopsy was performed which confirmed the subcutaneous vasculitis. The physician noted the two dosed of vaccine were administered at another facility so she did not have the dated of administration or the lot numbers. The patient''s subcutaneous vasculitis persisted. Additional information has been requested.


New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=283939&WAYBACKHISTORY=ON


Copyright © 2017 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166