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This is VAERS ID 309086

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

309086
VAERS Form:
Age:17.0
Gender:Female
Location:Illinois
Vaccinated:2007-12-05
Onset:2007-12-06
Submitted:2008-04-08
Entered:2008-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER 15522U / 1 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pain, Injection site rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: none
Current Illness: denies
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Left arm sore with a red bumpy rash that extended down the arm. Patient states that rash lasted for one month. Did not call our office to report adverse reaction. Immunization administered was gardasil #2.


Changed on 12/8/2009

309086 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Illinois
Vaccinated:2007-12-05
Onset:2007-12-06
Submitted:2008-04-08
Entered:2008-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER 15522U / 1 LA / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Injection site erythema, Injection site pain, Injection site rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: none
Current Illness: denies
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Left arm sore with a red bumpy rash that extended down the arm. Patient states that rash lasted for one month. Did not call our office to report adverse reaction. Immunization administered was gardasil #2.


Changed on 7/13/2012

309086 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Illinois
Vaccinated:2007-12-05
Onset:2007-12-06
Submitted:2008-04-08
Entered:2008-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER 15522U / 1 LA / IM

Administered by: Private Unknown      Purchased by: Private Unknown
Symptoms: Injection site erythema, Injection site pain, Injection site rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: none
Current Illness: denies
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Left arm sore with a red bumpy rash that extended down the arm. Patient states that rash lasted for one month. Did not call our office to report adverse reaction. Immunization administered was gardasil Gardasil #2.


Changed on 6/14/2014

309086 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Illinois
Vaccinated:2007-12-05
Onset:2007-12-06
Submitted:2008-04-08
Entered:2008-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER 15522U / 1 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pain, Injection site rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: none
Current Illness: denies
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Left arm sore with a red bumpy rash that extended down the arm. Patient states that rash lasted for one month. Did not call our office to report adverse reaction. Immunization administered was Gardasil #2.


Changed on 4/14/2017

309086 Before After
VAERS Form:
Age:17.0
Gender:Female
Location:Illinois
Vaccinated:2007-12-05
Onset:2007-12-06
Submitted:2008-04-08
Entered:2008-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER 15522U / 1 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pain, Injection site rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: none
Current Illness: denies
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Left arm sore with a red bumpy rash that extended down the arm. Patient states that rash lasted for one month. Did not call our office to report adverse reaction. Immunization administered was Gardasil #2.


Changed on 9/14/2017

309086 Before After
VAERS Form:(blank) 1
Age:17.0
Gender:Female
Location:Illinois
Vaccinated:2007-12-05
Onset:2007-12-06
Submitted:2008-04-08
Entered:2008-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER 15522U / 1 2 LA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pain, Injection site rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: none
Current Illness: denies
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Left arm sore with a red bumpy rash that extended down the arm. Patient states that rash lasted for one month. Did not call our office to report adverse reaction. Immunization administered was Gardasil #2.


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