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This is VAERS ID 284100

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

284100
VAERS Form:
Age:18.0
Gender:Female
Location:Alabama
Vaccinated:2007-06-26
Onset:2007-06-26
Submitted:2007-07-06
Entered:2007-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0524U / 0 - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Pruritus, Urticaria

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: LEXAPRO, SEASONALE, PROTONIX
Current Illness: Gastrooesophageal reflux; Depression; Penicillin allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up:Information has been received from a licensed practical nurse concerning an 18 year old female with gastrooesophageal reflux, depression and a penicillin allergy who on 26-JUN-2007 was vaccinated intramuscularly with the first 0.5 ml dose of the Gardasil"(Lot # 658094/0524U). Concomitant therapy included LEXAPRO, SEASONALE and PROTONIX. Forty minutes after receiving the vaccination, the patient developed widespread hives and itching. The patient was evaluated in the local emergency room and was given intr


Changed on 12/8/2009

284100 Before After
VAERS Form:
Age:18.0
Gender:Female
Location:Alabama
Vaccinated:2007-06-26
Onset:2007-06-26
Submitted:2007-07-06
Entered:2007-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0524U / 0 - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Pruritus, Urticaria

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: LEXAPRO, SEASONALE, PROTONIX
Current Illness: Gastrooesophageal reflux; Depression; Penicillin allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type': (blank) WAES0706USA05121

Write-up:Information has been received from a licensed practical nurse concerning an 18 year old female with gastrooesophageal reflux, depression and a penicillin allergy who on 26-JUN-2007 was vaccinated intramuscularly with the first 0.5 ml dose of the Gardasil"(Lot Gardasil (Lot # 658094/0524U). Concomitant therapy included LEXAPRO, SEASONALE and PROTONIX. Forty minutes after receiving the vaccination, the patient developed widespread hives and itching. The patient was evaluated in the local emergency room and was given intr intravenous steroid treatment. The patient was not admitted to the hospital. No laboratory or diagnostic tests were performed. The patient outcome was unknown. The licensed practical nurse considered the widespread hives and itching to be other important medical events. Additional information has been requested.


Changed on 1/5/2010

284100 Before After
VAERS Form:
Age:18.0
Gender:Female
Location:Alabama
Vaccinated:2007-06-26
Onset:2007-06-26
Submitted:2007-07-06
Entered:2007-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0524U / 0 - UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Pruritus, Urticaria

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)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: LEXAPRO, SEASONALE, LEXAPRO; SEASONALE; PROTONIX
Current Illness: Gastrooesophageal reflux; Depression; Penicillin allergy
Preexisting Conditions: Gastrooesophageal reflux; Depression; Penicillin allergy
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type': WAES0706USA05121

Write-up:Information has been received from a licensed practical nurse concerning an 18 year old female with gastrooesophageal reflux, depression and a penicillin allergy who on 26-JUN-2007 was vaccinated intramuscularly with the first 0.5 ml dose of the Gardasil GARDASIL (Lot # 658094/0524U). Concomitant therapy included LEXAPRO, SEASONALE and PROTONIX. Forty minutes after receiving the vaccination, the patient developed widespread hives and itching. The patient was evaluated in the local emergency room and was given intravenous steroid treatment. The patient was not admitted to the hospital. No laboratory or diagnostic tests were performed. The patient outcome was unknown. The licensed practical nurse considered the widespread hives and itching to be other important medical events. Additional information has been requested.


Changed on 6/14/2014

284100 Before After
VAERS Form:
Age:18.0
Gender:Female
Location:Alabama
Vaccinated:2007-06-26
Onset:2007-06-26
Submitted:2007-07-06
Entered:2007-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0524U / 0 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Pruritus, Urticaria

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: LEXAPRO; SEASONALE; PROTONIX
Current Illness: Gastrooesophageal reflux; Depression; Penicillin allergy
Preexisting Conditions: Gastrooesophageal reflux; Depression; Penicillin allergy
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type': WAES0706USA05121

Write-up:Information has been received from a licensed practical nurse concerning an 18 year old female with gastrooesophageal reflux, depression and a penicillin allergy who on 26-JUN-2007 was vaccinated intramuscularly with the first 0.5 ml dose of the GARDASIL (Lot # 658094/0524U). Concomitant therapy included LEXAPRO, SEASONALE and PROTONIX. Forty minutes after receiving the vaccination, the patient developed widespread hives and itching. The patient was evaluated in the local emergency room and was given intravenous steroid treatment. The patient was not admitted to the hospital. No laboratory or diagnostic tests were performed. The patient outcome was unknown. The licensed practical nurse considered the widespread hives and itching to be other important medical events. Additional information has been requested.


Changed on 5/14/2017

284100 Before After
VAERS Form:
Age:18.0
Gender:Female
Location:Alabama
Vaccinated:2007-06-26
Onset:2007-06-26
Submitted:2007-07-06
Entered:2007-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0524U / 0 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Pruritus, Urticaria

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: LEXAPRO; SEASONALE; PROTONIX
Current Illness: Gastrooesophageal reflux; Depression; Penicillin allergy
Preexisting Conditions: Gastrooesophageal reflux; Depression; Penicillin allergy
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type': WAES0706USA05121

Write-up:Information has been received from a licensed practical nurse concerning an 18 year old female with gastrooesophageal reflux, depression and a penicillin allergy who on 26-JUN-2007 was vaccinated intramuscularly with the first 0.5 ml dose of the GARDASIL (Lot # 658094/0524U). Concomitant therapy included LEXAPRO, SEASONALE and PROTONIX. Forty minutes after receiving the vaccination, the patient developed widespread hives and itching. The patient was evaluated in the local emergency room and was given intravenous steroid treatment. The patient was not admitted to the hospital. No laboratory or diagnostic tests were performed. The patient outcome was unknown. The licensed practical nurse considered the widespread hives and itching to be other important medical events. Additional information has been requested.


Changed on 9/14/2017

284100 Before After
VAERS Form:(blank) 1
Age:18.0
Gender:Female
Location:Alabama
Vaccinated:2007-06-26
Onset:2007-06-26
Submitted:2007-07-06
Entered:2007-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0524U / 0 1 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Pruritus, Urticaria

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: LEXAPRO; SEASONALE; PROTONIX
Current Illness: Gastrooesophageal reflux; Depression; Penicillin allergy
Preexisting Conditions: Gastrooesophageal reflux; Depression; Penicillin allergy
Allergies:
Diagnostic Lab Data: None
CDC 'Split Type': WAES0706USA05121

Write-up:Information has been received from a licensed practical nurse concerning an 18 year old female with gastrooesophageal reflux, depression and a penicillin allergy who on 26-JUN-2007 was vaccinated intramuscularly with the first 0.5 ml dose of the GARDASIL (Lot # 658094/0524U). Concomitant therapy included LEXAPRO, SEASONALE and PROTONIX. Forty minutes after receiving the vaccination, the patient developed widespread hives and itching. The patient was evaluated in the local emergency room and was given intravenous steroid treatment. The patient was not admitted to the hospital. No laboratory or diagnostic tests were performed. The patient outcome was unknown. The licensed practical nurse considered the widespread hives and itching to be other important medical events. Additional information has been requested.


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