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This is VAERS ID 284483

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

284483
VAERS Form:
Age:17.0
Gender:Female
Location:Unknown
Vaccinated:2007-01-03
Onset:2007-01-03
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUZONE) / SANOFI PASTEUR - / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / - UN / UN
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR - / - UN / UN

Administered by: Other      Purchased by: Unknown
Symptoms: Injection site erythema, Injection site warmth, Skin lesion, Skin ulcer, Tenderness

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:
Current Illness: Latex allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up:This report was identified from a line listing obtained on request by the Company from the FDA under the Freedom of Information Act. A 17 year old female experienced injection site erythema, injection site warmth, skin ulcer and tenderness following vacci"nation with Gardasil. The patient experienced on the left deltoid site a 5 cm x 3 1/2 cm circular erythematous tender area that was warm to the touch, and a lesion that was very tender. No further information is available. The original reporting source w


Changed on 12/8/2009

284483 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Unknown
Vaccinated:2007-01-03
Onset:2007-01-03
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (FLUZONE) INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / - UN / UN
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR - / - UN / UN

Administered by: Other      Purchased by: Unknown Other
Symptoms: Injection site erythema, Injection site warmth, Skin lesion, Skin ulcer, Tenderness

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:
Current Illness: Latex allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': (blank) WAES0705USA04564

Write-up:This report was identified from a line listing obtained on request by the Company from the FDA under the Freedom of Information Act. A 17 year old female experienced injection site erythema, injection site warmth, skin ulcer and tenderness following vacci"nation vaccination with Gardasil. The patient experienced on the left deltoid site a 5 cm x 3 1/2 cm circular erythematous tender area that was warm to the touch, and a lesion that was very tender. No further information is available. The original reporting source w was not provided. Additional information has been requested.


Changed on 4/7/2010

284483 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Unknown
Vaccinated:2007-01-03
Onset:2007-01-03
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / - UN / UN
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Injection site erythema, Injection site warmth, Skin lesion, Skin ulcer, Tenderness

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:
Current Illness: Latex allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0705USA04564

Write-up:This report was identified from a line listing obtained on request by the Company from the FDA under the Freedom of Information Act. A 17 year old female experienced injection site erythema, injection site warmth, skin ulcer and tenderness following vaccination with Gardasil. The patient experienced on the left deltoid site a 5 cm x 3 1/2 cm circular erythematous tender area that was warm to the touch, and a lesion that was very tender. No further information is available. The original reporting source was not provided. Additional information has been requested.


Changed on 7/7/2013

284483 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Unknown
Vaccinated:2007-01-03
Onset:2007-01-03
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / - UN / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / - UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Injection site erythema, Injection site warmth, Skin lesion, Skin ulcer, Tenderness

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:
Current Illness: Latex allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0705USA04564

Write-up:This report was identified from a line listing obtained on request by the Company from the FDA under the Freedom of Information Act. A 17 year old female experienced injection site erythema, injection site warmth, skin ulcer and tenderness following vaccination with Gardasil. The patient experienced on the left deltoid site a 5 cm x 3 1/2 cm circular erythematous tender area that was warm to the touch, and a lesion that was very tender. No further information is available. The original reporting source was not provided. Additional information has been requested.


Changed on 9/14/2017

284483 Before After
VAERS Form:(blank) 1
Age:17.0
Gender:Female
Location:Unknown
Vaccinated:2007-01-03
Onset:2007-01-03
Submitted:2007-06-14
Entered:2007-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / - UNK UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0961F / - UNK UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / - UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Injection site erythema, Injection site warmth, Skin lesion, Skin ulcer, Tenderness

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:
Current Illness: Latex allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0705USA04564

Write-up:This report was identified from a line listing obtained on request by the Company from the FDA under the Freedom of Information Act. A 17 year old female experienced injection site erythema, injection site warmth, skin ulcer and tenderness following vaccination with Gardasil. The patient experienced on the left deltoid site a 5 cm x 3 1/2 cm circular erythematous tender area that was warm to the touch, and a lesion that was very tender. No further information is available. The original reporting source was not provided. Additional information has been requested.


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