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This is VAERS ID 291932

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 291932
VAERS Form:
Age:25.0
Sex:Female
Location:Massachusetts
Vaccinated:2007-06-06
Onset:2007-06-06
Submitted:2007-10-02
Entered:2007-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0524U / 0 UN / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Dyspnoea, Skin irritation, Urticaria

Life Threatening? Yes
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: therapy unspecified; CREATINE POWDER; PRILOSEC
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Information has been received from a nurse practitioner concerning a 25 year old female with no medical history and no drug allergies, who on 06-JUN-2007 was vaccinated with a first dose of Gardasil (Lot# 658094/0524U). Subsequently, the patient developed"local irritation. Concomitant therapy included /"creatine/" (CREATINE POWDER), /"glutamine/", /"omnijust/", and omeprazole (PRILOSEC). On 07-AUG-2007 the patient was vaccinated intramuscularly with a 0.5 mL second dose of Gardasil. On 07-AUG-2007 eight an


Changed on 12/8/2009

VAERS ID: 291932 Before After
VAERS Form:
Age:25.0
Sex:Female
Location:Massachusetts
Vaccinated:2007-06-06
Onset:2007-06-06
Submitted:2007-10-02
Entered:2007-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0524U / 0 UN / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Dyspnoea, Skin irritation, Urticaria

Life Threatening? Yes
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: therapy unspecified; CREATINE POWDER; PRILOSEC
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': (blank) WAES0709USA04315

Write-up: Information has been received from a nurse practitioner concerning a 25 year old female with no medical history and no drug allergies, who on 06-JUN-2007 was vaccinated with a first dose of Gardasil (Lot# 658094/0524U). Subsequently, the patient developed"local developed local irritation. Concomitant therapy included /"creatine/" "creatine" (CREATINE POWDER), /"glutamine/", /"omnijust/", "glutamine", "omnijust", and omeprazole (PRILOSEC). On 07-AUG-2007 the patient was vaccinated intramuscularly with a 0.5 mL second dose of Gardasil. On 07-AUG-2007 eight and a half hours after receiving the vaccination the patient developed hives and experienced difficulty breathing. The reaction occurred while she was running outdoors. The patient went to the emergency room and was released after being treated intravenously with diphenhydramine hydrochloride (BENADRYL). The patient recovered on an unspecified date. No product quality complaint was involved. The patient''s difficulty breathing was considered to be life threatening. Additional information has been requested.


Changed on 9/14/2017

VAERS ID: 291932 Before After
VAERS Form:(blank) 1
Age:25.0
Sex:Female
Location:Massachusetts
Vaccinated:2007-06-06
Onset:2007-06-06
Submitted:2007-10-02
Entered:2007-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0524U / 0 1 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, Skin irritation, Urticaria

Life Threatening? Yes
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: therapy unspecified; CREATINE POWDER; PRILOSEC
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0709USA04315

Write-up: Information has been received from a nurse practitioner concerning a 25 year old female with no medical history and no drug allergies, who on 06-JUN-2007 was vaccinated with a first dose of Gardasil (Lot# 658094/0524U). Subsequently, the patient developed local irritation. Concomitant therapy included "creatine" (CREATINE POWDER), "glutamine", "omnijust", and omeprazole (PRILOSEC). On 07-AUG-2007 the patient was vaccinated intramuscularly with a 0.5 mL second dose of Gardasil. On 07-AUG-2007 eight and a half hours after receiving the vaccination the patient developed hives and experienced difficulty breathing. The reaction occurred while she was running outdoors. The patient went to the emergency room and was released after being treated intravenously with diphenhydramine hydrochloride (BENADRYL). The patient recovered on an unspecified date. No product quality complaint was involved. The patient''s difficulty breathing was considered to be life threatening. Additional information has been requested.


Changed on 2/14/2018

VAERS ID: 291932 Before After
VAERS Form:1
Age:25.0
Sex:Female
Location:Massachusetts
Vaccinated:2007-06-06
Onset:2007-06-06
Submitted:2007-10-02
Entered:2007-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0524U / 1 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, Skin irritation, Urticaria

Life Threatening? Yes
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: therapy unspecified; CREATINE POWDER; PRILOSEC
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0709USA04315

Write-up: Information has been received from a nurse practitioner concerning a 25 year old female with no medical history and no drug allergies, who on 06-JUN-2007 was vaccinated with a first dose of Gardasil (Lot# 658094/0524U). Subsequently, the patient developed local irritation. Concomitant therapy included "creatine" (CREATINE POWDER), "glutamine", "omnijust", and omeprazole (PRILOSEC). On 07-AUG-2007 the patient was vaccinated intramuscularly with a 0.5 mL second dose of Gardasil. On 07-AUG-2007 eight and a half hours after receiving the vaccination the patient developed hives and experienced difficulty breathing. The reaction occurred while she was running outdoors. The patient went to the emergency room and was released after being treated intravenously with diphenhydramine hydrochloride (BENADRYL). The patient recovered on an unspecified date. No product quality complaint was involved. The patient''s difficulty breathing was considered to be life threatening. Additional information has been requested.


Changed on 6/14/2018

VAERS ID: 291932 Before After
VAERS Form:1
Age:25.0
Sex:Female
Location:Massachusetts
Vaccinated:2007-06-06
Onset:2007-06-06
Submitted:2007-10-02
Entered:2007-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0524U / 1 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, Skin irritation, Urticaria

Life Threatening? Yes
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: therapy unspecified; CREATINE POWDER; PRILOSEC
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0709USA04315

Write-up: Information has been received from a nurse practitioner concerning a 25 year old female with no medical history and no drug allergies, who on 06-JUN-2007 was vaccinated with a first dose of Gardasil (Lot# 658094/0524U). Subsequently, the patient developed local irritation. Concomitant therapy included "creatine" (CREATINE POWDER), "glutamine", "omnijust", and omeprazole (PRILOSEC). On 07-AUG-2007 the patient was vaccinated intramuscularly with a 0.5 mL second dose of Gardasil. On 07-AUG-2007 eight and a half hours after receiving the vaccination the patient developed hives and experienced difficulty breathing. The reaction occurred while she was running outdoors. The patient went to the emergency room and was released after being treated intravenously with diphenhydramine hydrochloride (BENADRYL). The patient recovered on an unspecified date. No product quality complaint was involved. The patient''s difficulty breathing was considered to be life threatening. Additional information has been requested.


Changed on 8/14/2018

VAERS ID: 291932 Before After
VAERS Form:1
Age:25.0
Sex:Female
Location:Massachusetts
Vaccinated:2007-06-06
Onset:2007-06-06
Submitted:2007-10-02
Entered:2007-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0524U / 1 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, Skin irritation, Urticaria

Life Threatening? Yes
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: therapy unspecified; CREATINE POWDER; PRILOSEC
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0709USA04315

Write-up: Information has been received from a nurse practitioner concerning a 25 year old female with no medical history and no drug allergies, who on 06-JUN-2007 was vaccinated with a first dose of Gardasil (Lot# 658094/0524U). Subsequently, the patient developed local irritation. Concomitant therapy included "creatine" (CREATINE POWDER), "glutamine", "omnijust", and omeprazole (PRILOSEC). On 07-AUG-2007 the patient was vaccinated intramuscularly with a 0.5 mL second dose of Gardasil. On 07-AUG-2007 eight and a half hours after receiving the vaccination the patient developed hives and experienced difficulty breathing. The reaction occurred while she was running outdoors. The patient went to the emergency room and was released after being treated intravenously with diphenhydramine hydrochloride (BENADRYL). The patient recovered on an unspecified date. No product quality complaint was involved. The patient''s difficulty breathing was considered to be life threatening. Additional information has been requested.


Changed on 9/14/2018

VAERS ID: 291932 Before After
VAERS Form:1
Age:25.0
Sex:Female
Location:Massachusetts
Vaccinated:2007-06-06
Onset:2007-06-06
Submitted:2007-10-02
Entered:2007-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0524U / 1 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, Skin irritation, Urticaria

Life Threatening? Yes
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: therapy unspecified; CREATINE POWDER; PRILOSEC
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0709USA04315

Write-up: Information has been received from a nurse practitioner concerning a 25 year old female with no medical history and no drug allergies, who on 06-JUN-2007 was vaccinated with a first dose of Gardasil (Lot# 658094/0524U). Subsequently, the patient developed local irritation. Concomitant therapy included "creatine" (CREATINE POWDER), "glutamine", "omnijust", and omeprazole (PRILOSEC). On 07-AUG-2007 the patient was vaccinated intramuscularly with a 0.5 mL second dose of Gardasil. On 07-AUG-2007 eight and a half hours after receiving the vaccination the patient developed hives and experienced difficulty breathing. The reaction occurred while she was running outdoors. The patient went to the emergency room and was released after being treated intravenously with diphenhydramine hydrochloride (BENADRYL). The patient recovered on an unspecified date. No product quality complaint was involved. The patient''s difficulty breathing was considered to be life threatening. Additional information has been requested.


Changed on 10/14/2018

VAERS ID: 291932 Before After
VAERS Form:1
Age:25.0
Sex:Female
Location:Massachusetts
Vaccinated:2007-06-06
Onset:2007-06-06
Submitted:2007-10-02
Entered:2007-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0524U / 1 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, Skin irritation, Urticaria

Life Threatening? Yes
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: therapy unspecified; CREATINE POWDER; PRILOSEC
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0709USA04315

Write-up: Information has been received from a nurse practitioner concerning a 25 year old female with no medical history and no drug allergies, who on 06-JUN-2007 was vaccinated with a first dose of Gardasil (Lot# 658094/0524U). Subsequently, the patient developed local irritation. Concomitant therapy included "creatine" (CREATINE POWDER), "glutamine", "omnijust", and omeprazole (PRILOSEC). On 07-AUG-2007 the patient was vaccinated intramuscularly with a 0.5 mL second dose of Gardasil. On 07-AUG-2007 eight and a half hours after receiving the vaccination the patient developed hives and experienced difficulty breathing. The reaction occurred while she was running outdoors. The patient went to the emergency room and was released after being treated intravenously with diphenhydramine hydrochloride (BENADRYL). The patient recovered on an unspecified date. No product quality complaint was involved. The patient''s difficulty breathing was considered to be life threatening. Additional information has been requested.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=291932&WAYBACKHISTORY=ON


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