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This is VAERS ID 297532

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 297532
VAERS Form:
Age:19.0
Sex:Female
Location:Missouri
Vaccinated:2007-10-19
Onset:2007-10-19
Submitted:2007-11-20
Entered:2007-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0387U / - UN / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Dyspnoea, Pain in extremity, Pharyngeal oedema, Rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: ORTHO TRI-CYCLEN; DIPENTUM; PRILOSEC; SEROQUEL; EFFEXOR
Current Illness: Depression; Anxiety; Gastrooesophageal reflux disease; Drug hypersensitivity
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Information has been received from a licensed practical nurse concerning a 19 year old female with depression, anxiety and gastroesophageal reflux disease and a history of drug hypersensitivity to PREDNISONE, ZOLOFT and /"BENREX/" who on 19-OCT-2007 was v"accinated intramuscularly with a 0.5ml dose of Gardasil (lot# 657621/0387U). Concomitant therapy included PRILOSEC, DIFENTUM, EFFEXOR, SEROQUEL and ORTHO TRI-CYCLEN. On 19-OCT-2007, the patient experienced difficulty breathing with possible throat swellin


Changed on 12/8/2009

VAERS ID: 297532 Before After
VAERS Form:
Age:19.0
Sex:Female
Location:Missouri
Vaccinated:2007-10-19
Onset:2007-10-19
Submitted:2007-11-20
Entered:2007-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0387U / - UN / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Dyspnoea, Pain in extremity, Pharyngeal oedema, Rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: ORTHO TRI-CYCLEN; DIPENTUM; PRILOSEC; SEROQUEL; EFFEXOR
Current Illness: Depression; Anxiety; Gastrooesophageal reflux disease; Drug hypersensitivity
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': (blank) WAES0711USA02887

Write-up: Information has been received from a licensed practical nurse concerning a 19 year old female with depression, anxiety and gastroesophageal reflux disease and a history of drug hypersensitivity to PREDNISONE, ZOLOFT and /"BENREX/" "BENREX" who on 19-OCT-2007 was v"accinated vaccinated intramuscularly with a 0.5ml dose of Gardasil (lot# 657621/0387U). Concomitant therapy included PRILOSEC, DIFENTUM, EFFEXOR, SEROQUEL and ORTHO TRI-CYCLEN. On 19-OCT-2007, the patient experienced difficulty breathing with possible throat swellin swelling post vaccination. The patient also had arm pain and bumps on arm (not specific). The patient was treated in the emergency room with VISTARIL and ULTRAM and was hospitalized overnight. Additional information has been requested.


Changed on 9/14/2017

VAERS ID: 297532 Before After
VAERS Form:(blank) 1
Age:19.0
Sex:Female
Location:Missouri
Vaccinated:2007-10-19
Onset:2007-10-19
Submitted:2007-11-20
Entered:2007-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0387U / - UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, Pain in extremity, Pharyngeal oedema, Rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: ORTHO TRI-CYCLEN; DIPENTUM; PRILOSEC; SEROQUEL; EFFEXOR
Current Illness: Depression; Anxiety; Gastrooesophageal reflux disease; Drug hypersensitivity
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0711USA02887

Write-up: Information has been received from a licensed practical nurse concerning a 19 year old female with depression, anxiety and gastroesophageal reflux disease and a history of drug hypersensitivity to PREDNISONE, ZOLOFT and "BENREX" who on 19-OCT-2007 was vaccinated intramuscularly with a 0.5ml dose of Gardasil (lot# 657621/0387U). Concomitant therapy included PRILOSEC, DIFENTUM, EFFEXOR, SEROQUEL and ORTHO TRI-CYCLEN. On 19-OCT-2007, the patient experienced difficulty breathing with possible throat swelling post vaccination. The patient also had arm pain and bumps on arm (not specific). The patient was treated in the emergency room with VISTARIL and ULTRAM and was hospitalized overnight. Additional information has been requested.


Changed on 2/14/2018

VAERS ID: 297532 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:Missouri
Vaccinated:2007-10-19
Onset:2007-10-19
Submitted:2007-11-20
Entered:2007-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0387U / UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, Pain in extremity, Pharyngeal oedema, Rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: ORTHO TRI-CYCLEN; DIPENTUM; PRILOSEC; SEROQUEL; EFFEXOR
Current Illness: Depression; Anxiety; Gastrooesophageal reflux disease; Drug hypersensitivity
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0711USA02887

Write-up: Information has been received from a licensed practical nurse concerning a 19 year old female with depression, anxiety and gastroesophageal reflux disease and a history of drug hypersensitivity to PREDNISONE, ZOLOFT and "BENREX" who on 19-OCT-2007 was vaccinated intramuscularly with a 0.5ml dose of Gardasil (lot# 657621/0387U). Concomitant therapy included PRILOSEC, DIFENTUM, EFFEXOR, SEROQUEL and ORTHO TRI-CYCLEN. On 19-OCT-2007, the patient experienced difficulty breathing with possible throat swelling post vaccination. The patient also had arm pain and bumps on arm (not specific). The patient was treated in the emergency room with VISTARIL and ULTRAM and was hospitalized overnight. Additional information has been requested.


Changed on 6/14/2018

VAERS ID: 297532 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:Missouri
Vaccinated:2007-10-19
Onset:2007-10-19
Submitted:2007-11-20
Entered:2007-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0387U / UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, Pain in extremity, Pharyngeal oedema, Rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: ORTHO TRI-CYCLEN; DIPENTUM; PRILOSEC; SEROQUEL; EFFEXOR
Current Illness: Depression; Anxiety; Gastrooesophageal reflux disease; Drug hypersensitivity
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0711USA02887

Write-up: Information has been received from a licensed practical nurse concerning a 19 year old female with depression, anxiety and gastroesophageal reflux disease and a history of drug hypersensitivity to PREDNISONE, ZOLOFT and "BENREX" who on 19-OCT-2007 was vaccinated intramuscularly with a 0.5ml dose of Gardasil (lot# 657621/0387U). Concomitant therapy included PRILOSEC, DIFENTUM, EFFEXOR, SEROQUEL and ORTHO TRI-CYCLEN. On 19-OCT-2007, the patient experienced difficulty breathing with possible throat swelling post vaccination. The patient also had arm pain and bumps on arm (not specific). The patient was treated in the emergency room with VISTARIL and ULTRAM and was hospitalized overnight. Additional information has been requested.


Changed on 8/14/2018

VAERS ID: 297532 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:Missouri
Vaccinated:2007-10-19
Onset:2007-10-19
Submitted:2007-11-20
Entered:2007-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0387U / UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, Pain in extremity, Pharyngeal oedema, Rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: ORTHO TRI-CYCLEN; DIPENTUM; PRILOSEC; SEROQUEL; EFFEXOR
Current Illness: Depression; Anxiety; Gastrooesophageal reflux disease; Drug hypersensitivity
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0711USA02887

Write-up: Information has been received from a licensed practical nurse concerning a 19 year old female with depression, anxiety and gastroesophageal reflux disease and a history of drug hypersensitivity to PREDNISONE, ZOLOFT and "BENREX" who on 19-OCT-2007 was vaccinated intramuscularly with a 0.5ml dose of Gardasil (lot# 657621/0387U). Concomitant therapy included PRILOSEC, DIFENTUM, EFFEXOR, SEROQUEL and ORTHO TRI-CYCLEN. On 19-OCT-2007, the patient experienced difficulty breathing with possible throat swelling post vaccination. The patient also had arm pain and bumps on arm (not specific). The patient was treated in the emergency room with VISTARIL and ULTRAM and was hospitalized overnight. Additional information has been requested.


Changed on 9/14/2018

VAERS ID: 297532 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:Missouri
Vaccinated:2007-10-19
Onset:2007-10-19
Submitted:2007-11-20
Entered:2007-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0387U / UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, Pain in extremity, Pharyngeal oedema, Rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: ORTHO TRI-CYCLEN; DIPENTUM; PRILOSEC; SEROQUEL; EFFEXOR
Current Illness: Depression; Anxiety; Gastrooesophageal reflux disease; Drug hypersensitivity
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0711USA02887

Write-up: Information has been received from a licensed practical nurse concerning a 19 year old female with depression, anxiety and gastroesophageal reflux disease and a history of drug hypersensitivity to PREDNISONE, ZOLOFT and "BENREX" who on 19-OCT-2007 was vaccinated intramuscularly with a 0.5ml dose of Gardasil (lot# 657621/0387U). Concomitant therapy included PRILOSEC, DIFENTUM, EFFEXOR, SEROQUEL and ORTHO TRI-CYCLEN. On 19-OCT-2007, the patient experienced difficulty breathing with possible throat swelling post vaccination. The patient also had arm pain and bumps on arm (not specific). The patient was treated in the emergency room with VISTARIL and ULTRAM and was hospitalized overnight. Additional information has been requested.


Changed on 10/14/2018

VAERS ID: 297532 Before After
VAERS Form:1
Age:19.0
Sex:Female
Location:Missouri
Vaccinated:2007-10-19
Onset:2007-10-19
Submitted:2007-11-20
Entered:2007-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0387U / UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Dyspnoea, Pain in extremity, Pharyngeal oedema, Rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 1     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: ORTHO TRI-CYCLEN; DIPENTUM; PRILOSEC; SEROQUEL; EFFEXOR
Current Illness: Depression; Anxiety; Gastrooesophageal reflux disease; Drug hypersensitivity
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0711USA02887

Write-up: Information has been received from a licensed practical nurse concerning a 19 year old female with depression, anxiety and gastroesophageal reflux disease and a history of drug hypersensitivity to PREDNISONE, ZOLOFT and "BENREX" who on 19-OCT-2007 was vaccinated intramuscularly with a 0.5ml dose of Gardasil (lot# 657621/0387U). Concomitant therapy included PRILOSEC, DIFENTUM, EFFEXOR, SEROQUEL and ORTHO TRI-CYCLEN. On 19-OCT-2007, the patient experienced difficulty breathing with possible throat swelling post vaccination. The patient also had arm pain and bumps on arm (not specific). The patient was treated in the emergency room with VISTARIL and ULTRAM and was hospitalized overnight. Additional information has been requested.

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