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This is VAERS ID 404921

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History of Changes from the VAERS Wayback Machine

First Appeared on 11/3/2010

VAERS ID: 404921
VAERS Form:
Age:11.0
Sex:Female
Location:Texas
Vaccinated:2010-10-14
Onset:2010-10-14
Submitted:2010-10-14
Entered:2010-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA113AA / 3 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3442BA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR AC52B051AB / 0 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Urticaria, Immediate post-injection reaction

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Hives on back, arms and neck immediately after vaccines given - Provider - ordered BENADRYL x 1 dose of 1 tsp given - no further reaction noted.


Changed on 6/14/2014

VAERS ID: 404921 Before After
VAERS Form:
Age:11.0
Sex:Female
Location:Texas
Vaccinated:2010-10-14
Onset:2010-10-14
Submitted:2010-10-14
Entered:2010-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA113AA / 3 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3442BA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR AC52B051AB / 0 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Urticaria, Immediate post-injection reaction

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Hives on back, arms and neck immediately after vaccines given - Provider - ordered BENADRYL x 1 dose of 1 tsp given - no further reaction noted.


Changed on 4/14/2017

VAERS ID: 404921 Before After
VAERS Form:
Age:11.0
Sex:Female
Location:Texas
Vaccinated:2010-10-14
Onset:2010-10-14
Submitted:2010-10-14
Entered:2010-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA113AA / 3 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3442BA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR AC52B051AB / 0 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Urticaria, Immediate post-injection reaction

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Hives on back, arms and neck immediately after vaccines given - Provider - ordered BENADRYL x 1 dose of 1 tsp given - no further reaction noted.


Changed on 9/14/2017

VAERS ID: 404921 Before After
VAERS Form:(blank) 1
Age:11.0
Sex:Female
Location:Texas
Vaccinated:2010-10-14
Onset:2010-10-14
Submitted:2010-10-14
Entered:2010-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA113AA / 3 4 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3442BA / 0 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR AC52B051AB / 0 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Urticaria, Immediate post-injection reaction

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Hives on back, arms and neck immediately after vaccines given - Provider - ordered BENADRYL x 1 dose of 1 tsp given - no further reaction noted.


Changed on 2/14/2018

VAERS ID: 404921 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Texas
Vaccinated:2010-10-14
Onset:2010-10-14
Submitted:2010-10-14
Entered:2010-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA113AA / 4 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3442BA / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR AC52B051AB / 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Urticaria, Immediate post-injection reaction

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Hives on back, arms and neck immediately after vaccines given - Provider - ordered BENADRYL x 1 dose of 1 tsp given - no further reaction noted.


Changed on 6/14/2018

VAERS ID: 404921 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Texas
Vaccinated:2010-10-14
Onset:2010-10-14
Submitted:2010-10-14
Entered:2010-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA113AA / 4 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3442BA / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR AC52B051AB / 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Urticaria, Immediate post-injection reaction

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Hives on back, arms and neck immediately after vaccines given - Provider - ordered BENADRYL x 1 dose of 1 tsp given - no further reaction noted.


Changed on 8/14/2018

VAERS ID: 404921 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Texas
Vaccinated:2010-10-14
Onset:2010-10-14
Submitted:2010-10-14
Entered:2010-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA113AA / 4 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3442BA / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR AC52B051AB / 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Urticaria, Immediate post-injection reaction

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Hives on back, arms and neck immediately after vaccines given - Provider - ordered BENADRYL x 1 dose of 1 tsp given - no further reaction noted.


Changed on 9/14/2018

VAERS ID: 404921 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Texas
Vaccinated:2010-10-14
Onset:2010-10-14
Submitted:2010-10-14
Entered:2010-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA113AA / 4 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3442BA / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR AC52B051AB / 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Urticaria, Immediate post-injection reaction

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Hives on back, arms and neck immediately after vaccines given - Provider - ordered BENADRYL x 1 dose of 1 tsp given - no further reaction noted.


Changed on 10/14/2018

VAERS ID: 404921 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Texas
Vaccinated:2010-10-14
Onset:2010-10-14
Submitted:2010-10-14
Entered:2010-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA113AA / 4 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3442BA / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR AC52B051AB / 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Urticaria, Immediate post-injection reaction

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Hives on back, arms and neck immediately after vaccines given - Provider - ordered BENADRYL x 1 dose of 1 tsp given - no further reaction noted.


Changed on 12/24/2020

VAERS ID: 404921 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Texas
Vaccinated:2010-10-14
Onset:2010-10-14
Submitted:2010-10-14
Entered:2010-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA113AA / 4 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3442BA / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR AC52B051AB / 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Urticaria, Immediate post-injection reaction

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Hives on back, arms and neck immediately after vaccines given - Provider - ordered BENADRYL x 1 dose of 1 tsp given - no further reaction noted.


Changed on 12/30/2020

VAERS ID: 404921 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Texas
Vaccinated:2010-10-14
Onset:2010-10-14
Submitted:2010-10-14
Entered:2010-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA113AA / 4 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3442BA / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR AC52B051AB / 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Urticaria, Immediate post-injection reaction

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Hives on back, arms and neck immediately after vaccines given - Provider - ordered BENADRYL x 1 dose of 1 tsp given - no further reaction noted.


Changed on 5/7/2021

VAERS ID: 404921 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Texas
Vaccinated:2010-10-14
Onset:2010-10-14
Submitted:2010-10-14
Entered:2010-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA113AA / 4 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3442BA / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR AC52B051AB / 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Urticaria, Immediate post-injection reaction

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Hives on back, arms and neck immediately after vaccines given - Provider - ordered BENADRYL x 1 dose of 1 tsp given - no further reaction noted.


Changed on 5/21/2021

VAERS ID: 404921 Before After
VAERS Form:1
Age:11.0
Sex:Female
Location:Texas
Vaccinated:2010-10-14
Onset:2010-10-14
Submitted:2010-10-14
Entered:2010-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA113AA / 4 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3442BA / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR AC52B051AB / 1 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Urticaria, Immediate post-injection reaction

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Hives on back, arms and neck immediately after vaccines given - Provider - ordered BENADRYL x 1 dose of 1 tsp given - no further reaction noted.

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