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This is VAERS ID 284170

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 284170
Age:18.0
Gender:Female
Location:California
Vaccinated:2007-05-15
Onset:2007-05-17
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: Unknown
Symptoms: Rash, No reaction on previous exposure to drug

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: hormonal contraceptives
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up:Information has been received from a physician concerning an 18 year old female with no allergies, who on 15-MAY-2007 was vaccinated with a second 0.5 ml dose of Gardasil. Concomitant therapy included hormonal contraceptives (unspecified). On 17-MAY-2007,"the patient developed a small fine rash. It was reported that on 15-MAR-2007, the patient received a first dose of Gardasil and did not experience any adverse event. Unspecified medical attention was sought. No diagnostic laboratory studies were performed


Changed on 12/8/2009

VAERS ID: 284170 Before After
Age:18.0
Gender:Female
Location:California
Vaccinated:2007-05-15
Onset:2007-05-17
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: Unknown Other
Symptoms: Rash, No reaction on previous exposure to drug

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: hormonal contraceptives
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC 'Split Type': (blank) WAES0705USA03913

Write-up:Information has been received from a physician concerning an 18 year old female with no allergies, who on 15-MAY-2007 was vaccinated with a second 0.5 ml dose of Gardasil. Concomitant therapy included hormonal contraceptives (unspecified). On 17-MAY-2007,"the 17-MAY-2007, the patient developed a small fine rash. It was reported that on 15-MAR-2007, the patient received a first dose of Gardasil and did not experience any adverse event. Unspecified medical attention was sought. No diagnostic laboratory studies were performed performed. At the time of this report, the patient''s outcome was unknown. No product quality complaint was involved. Additional information has been requested.


Changed on 3/2/2010

VAERS ID: 284170 Before After
Age:18.0
Gender:Female
Location:California
Vaccinated:2007-05-15
Onset:2007-05-17
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - 0389U / 1 UN LA / UN IM

Administered by: Other      Purchased by: Other Private
Symptoms: Rash, No reaction on previous exposure to drug

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: hormonal contraceptives
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC 'Split Type': WAES0705USA03913

Write-up:This is in follow-up to report(s) previously submitted on 6/14/2007. Information has been received from a physician concerning an 18 year old female with no allergies, unspecified allergies and acne and a history of chickenpox and eczema, who on 15-MAY-2007 at 17:25 was vaccinated IM into the left deltoid with a second 0.5 ml dose of Gardasil. GARDASIL (lot# 657736/0389U). Concomitant therapy included hormonal contraceptives (unspecified). On 17-MAY-2007, the patient developed a small fine rash. It was reported that on 15-MAR-2007, the patient received a first dose of Gardasil and did not experience any adverse event. Unspecified medical attention was sought. No diagnostic laboratory studies were performed. At the time of this report, the patient''s outcome was unknown. No product quality complaint was involved. Additional information has been requested.


Changed on 6/14/2014

VAERS ID: 284170 Before After
Age:18.0
Gender:Female
Location:California
Vaccinated:2007-05-15
Onset:2007-05-17
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0389U / 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Rash, No reaction on previous exposure to drug

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: hormonal contraceptives
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC 'Split Type': WAES0705USA03913

Write-up:This is in follow-up to report(s) previously submitted on 6/14/2007. Information has been received from a physician concerning an 18 year old female with unspecified allergies and acne and a history of chickenpox and eczema, who on 15-MAY-2007 at 17:25 was vaccinated IM into the left deltoid with a second 0.5 ml dose of GARDASIL (lot# 657736/0389U). Concomitant therapy included hormonal contraceptives (unspecified). On 17-MAY-2007, the patient developed a small fine rash. It was reported that on 15-MAR-2007, the patient received a first dose of Gardasil and did not experience any adverse event. Unspecified medical attention was sought. No diagnostic laboratory studies were performed. At the time of this report, the patient''s outcome was unknown. No product quality complaint was involved. Additional information has been requested.


Changed on 5/14/2017

VAERS ID: 284170 Before After
Age:18.0
Gender:Female
Location:California
Vaccinated:2007-05-15
Onset:2007-05-17
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0389U / 1 LA / IM

Administered by: Other      Purchased by: Private
Symptoms: Rash, No reaction on previous exposure to drug

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: hormonal contraceptives
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: None
CDC 'Split Type': WAES0705USA03913

Write-up:This is in follow-up to report(s) previously submitted on 6/14/2007. Information has been received from a physician concerning an 18 year old female with unspecified allergies and acne and a history of chickenpox and eczema, who on 15-MAY-2007 at 17:25 was vaccinated IM into the left deltoid with a second 0.5 ml dose of GARDASIL (lot# 657736/0389U). Concomitant therapy included hormonal contraceptives (unspecified). On 17-MAY-2007, the patient developed a small fine rash. It was reported that on 15-MAR-2007, the patient received a first dose of Gardasil and did not experience any adverse event. Unspecified medical attention was sought. No diagnostic laboratory studies were performed. At the time of this report, the patient''s outcome was unknown. No product quality complaint was involved. Additional information has been requested.


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