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This is VAERS ID 284482

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

284482
VAERS Form:
Age:15.0
Gender:Female
Location:Texas
Vaccinated:2007-04-05
Onset:2007-04-05
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Erythema, Oedema peripheral

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:
CDC 'Split Type':

Write-up:Information has been received from a physician concerning a 15 year old female who on 05-APR-2007 was vaccinated with Gardasil (Lot#654702/0011U). On 05-APR-2007 post vaccination the patient developed a red swollen arm. Unspecified medical attention was s"ought. On 09-APR-2007 the patient recovered from the red swollen arm. Additional information has been requested.


Changed on 12/8/2009

284482 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Texas
Vaccinated:2007-04-05
Onset:2007-04-05
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / - - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Erythema, Oedema peripheral

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:
CDC 'Split Type': (blank) WAES0705USA04525

Write-up:Information has been received from a physician concerning a 15 year old female who on 05-APR-2007 was vaccinated with Gardasil (Lot#654702/0011U). On 05-APR-2007 post vaccination the patient developed a red swollen arm. Unspecified medical attention was s"ought. sought. On 09-APR-2007 the patient recovered from the red swollen arm. Additional information has been requested.


Changed on 3/2/2010

284482 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Texas
Vaccinated:2007-04-05
Onset:2007-04-05
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / - 0 - UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Erythema, Oedema peripheral

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:
CDC 'Split Type': WAES0705USA04525

Write-up:Information has been received from a physician concerning a 15 year old female who on 05-APR-2007 was vaccinated with Gardasil (Lot#654702/0011U). On 05-APR-2007 post vaccination the patient developed a red swollen arm. Unspecified medical attention was sought. On Subsequently on 09-APR-2007 the patient recovered from the red swollen arm. Additional information has been requested. In follow-up it was reported from a physician concerning a 15 year old female student whose reported weight was 158 pounds and whose reported height was 66 3/4 inches who on 05-APR-2007 was vaccinated intramuscularly into the left arm with the first dose of GARDASIL vaccine (yeast) (Lot #654702/0023U). It was reorted that on 05-APR-2007, the patient developed left shoulder and upper arm swelling and pain which lasted for 3 days. The patient recovered on 09-APR-2007. It was reported that the patient recovered. No additional information is expected.


Changed on 6/14/2014

284482 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Texas
Vaccinated:2007-04-05
Onset:2007-04-05
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / 0 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Erythema, Oedema peripheral

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:
CDC 'Split Type': WAES0705USA04525

Write-up:Information has been received from a physician concerning a 15 year old female who on 05-APR-2007 was vaccinated with Gardasil (Lot#654702/0011U). On 05-APR-2007 post vaccination the patient developed a red swollen arm. Unspecified medical attention was sought. Subsequently on 09-APR-2007 the patient recovered from the red swollen arm. Additional information has been requested. In follow-up it was reported from a physician concerning a 15 year old female student whose reported weight was 158 pounds and whose reported height was 66 3/4 inches who on 05-APR-2007 was vaccinated intramuscularly into the left arm with the first dose of GARDASIL vaccine (yeast) (Lot #654702/0023U). It was reorted that on 05-APR-2007, the patient developed left shoulder and upper arm swelling and pain which lasted for 3 days. The patient recovered on 09-APR-2007. It was reported that the patient recovered. No additional information is expected.


Changed on 5/14/2017

284482 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Texas
Vaccinated:2007-04-05
Onset:2007-04-05
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / 0 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Erythema, Oedema peripheral

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:
CDC 'Split Type': WAES0705USA04525

Write-up:Information has been received from a physician concerning a 15 year old female who on 05-APR-2007 was vaccinated with Gardasil (Lot#654702/0011U). On 05-APR-2007 post vaccination the patient developed a red swollen arm. Unspecified medical attention was sought. Subsequently on 09-APR-2007 the patient recovered from the red swollen arm. Additional information has been requested. In follow-up it was reported from a physician concerning a 15 year old female student whose reported weight was 158 pounds and whose reported height was 66 3/4 inches who on 05-APR-2007 was vaccinated intramuscularly into the left arm with the first dose of GARDASIL vaccine (yeast) (Lot #654702/0023U). It was reorted that on 05-APR-2007, the patient developed left shoulder and upper arm swelling and pain which lasted for 3 days. The patient recovered on 09-APR-2007. It was reported that the patient recovered. No additional information is expected.


Changed on 9/14/2017

284482 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:Texas
Vaccinated:2007-04-05
Onset:2007-04-05
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0011U / 0 1 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Erythema, Oedema peripheral

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:
CDC 'Split Type': WAES0705USA04525

Write-up:Information has been received from a physician concerning a 15 year old female who on 05-APR-2007 was vaccinated with Gardasil (Lot#654702/0011U). On 05-APR-2007 post vaccination the patient developed a red swollen arm. Unspecified medical attention was sought. Subsequently on 09-APR-2007 the patient recovered from the red swollen arm. Additional information has been requested. In follow-up it was reported from a physician concerning a 15 year old female student whose reported weight was 158 pounds and whose reported height was 66 3/4 inches who on 05-APR-2007 was vaccinated intramuscularly into the left arm with the first dose of GARDASIL vaccine (yeast) (Lot #654702/0023U). It was reorted that on 05-APR-2007, the patient developed left shoulder and upper arm swelling and pain which lasted for 3 days. The patient recovered on 09-APR-2007. It was reported that the patient recovered. No additional information is expected.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=284482&WAYBACKHISTORY=ON


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