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This is VAERS ID 407067

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/7/2010

VAERS ID: 407067
VAERS Form:
Age:12.0
Sex:Female
Location:Alabama
Vaccinated:2010-11-03
Onset:2010-11-05
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(10-11): INFLUENZA (SEASONAL) (FLUZONE 10-11) / SANOFI PASTEUR UT3569BA / 2 LL / UN
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA113AA / 0 LL / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Joint swelling, Urticaria

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? No
Previous Vaccinations:
Other Medications: SINGULAIR - PO - 5mg
Current Illness: No
Preexisting Conditions: NNDA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Urticarial rash, swelling in ankles & wrists.


Changed on 7/12/2011

VAERS ID: 407067 Before After
VAERS Form:
Age:12.0
Sex:Female
Location:Alabama
Vaccinated:2010-11-03
Onset:2010-11-05
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3569BA / 2 LL / UN
FLU(10-11): INFLUENZA (SEASONAL) (FLUZONE 10-11) / SANOFI PASTEUR UT3569BA / 2 LL / UN
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA113AA / 0 LL / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Joint swelling, Urticaria

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? No
Previous Vaccinations:
Other Medications: SINGULAIR - PO - 5mg
Current Illness: No
Preexisting Conditions: NNDA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Urticarial rash, swelling in ankles & wrists.


Changed on 7/7/2013

VAERS ID: 407067 Before After
VAERS Form:
Age:12.0
Sex:Female
Location:Alabama
Vaccinated:2010-11-03
Onset:2010-11-05
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3569BA / 2 LL / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3569BA / 2 LL / UN
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA113AA / 0 LL / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Joint swelling, Urticaria

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? No
Previous Vaccinations:
Other Medications: SINGULAIR - PO - 5mg
Current Illness: No
Preexisting Conditions: NNDA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Urticarial rash, swelling in ankles & wrists.


Changed on 6/14/2014

VAERS ID: 407067 Before After
VAERS Form:
Age:12.0
Sex:Female
Location:Alabama
Vaccinated:2010-11-03
Onset:2010-11-05
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3569BA / 2 LL / UN
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA113AA / 0 LL / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Joint swelling, Urticaria

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? No
Previous Vaccinations:
Other Medications: SINGULAIR - PO - 5mg
Current Illness: No
Preexisting Conditions: NNDA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Urticarial rash, swelling in ankles & wrists.


Changed on 4/14/2017

VAERS ID: 407067 Before After
VAERS Form:
Age:12.0
Sex:Female
Location:Alabama
Vaccinated:2010-11-03
Onset:2010-11-05
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3569BA / 2 LL / UN
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA113AA / 0 LL / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Joint swelling, Urticaria

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? No
Previous Vaccinations:
Other Medications: SINGULAIR - PO - 5mg
Current Illness: No
Preexisting Conditions: NNDA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Urticarial rash, swelling in ankles & wrists.


Changed on 9/14/2017

VAERS ID: 407067 Before After
VAERS Form:(blank) 1
Age:12.0
Sex:Female
Location:Alabama
Vaccinated:2010-11-03
Onset:2010-11-05
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3569BA / 2 3 LL / UN
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA113AA / 0 1 LL / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Joint swelling, Urticaria

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? No
Previous Vaccinations:
Other Medications: SINGULAIR - PO - 5mg
Current Illness: No
Preexisting Conditions: NNDA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Urticarial rash, swelling in ankles & wrists.


Changed on 2/14/2018

VAERS ID: 407067 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Alabama
Vaccinated:2010-11-03
Onset:2010-11-05
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3569BA / 3 LL / UN
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA113AA / 1 LL / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Joint swelling, Urticaria

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? No
Previous Vaccinations:
Other Medications: SINGULAIR - PO - 5mg
Current Illness: No
Preexisting Conditions: NNDA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Urticarial rash, swelling in ankles & wrists.


Changed on 6/14/2018

VAERS ID: 407067 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Alabama
Vaccinated:2010-11-03
Onset:2010-11-05
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3569BA / 3 LL / UN
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA113AA / 1 LL / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Joint swelling, Urticaria

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? No
Previous Vaccinations:
Other Medications: SINGULAIR - PO - 5mg
Current Illness: No
Preexisting Conditions: NNDA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Urticarial rash, swelling in ankles & wrists.


Changed on 8/14/2018

VAERS ID: 407067 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Alabama
Vaccinated:2010-11-03
Onset:2010-11-05
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3569BA / 3 LL / UN
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA113AA / 1 LL / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Joint swelling, Urticaria

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? No
Previous Vaccinations:
Other Medications: SINGULAIR - PO - 5mg
Current Illness: No
Preexisting Conditions: NNDA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Urticarial rash, swelling in ankles & wrists.


Changed on 9/14/2018

VAERS ID: 407067 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Alabama
Vaccinated:2010-11-03
Onset:2010-11-05
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3569BA / 3 LL / UN
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA113AA / 1 LL / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Joint swelling, Urticaria

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? No
Previous Vaccinations:
Other Medications: SINGULAIR - PO - 5mg
Current Illness: No
Preexisting Conditions: NNDA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Urticarial rash, swelling in ankles & wrists.


Changed on 10/14/2018

VAERS ID: 407067 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Alabama
Vaccinated:2010-11-03
Onset:2010-11-05
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3569BA / 3 LL / UN
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA113AA / 1 LL / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Joint swelling, Urticaria

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? No
Previous Vaccinations:
Other Medications: SINGULAIR - PO - 5mg
Current Illness: No
Preexisting Conditions: NNDA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Urticarial rash, swelling in ankles & wrists.


Changed on 12/24/2020

VAERS ID: 407067 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Alabama
Vaccinated:2010-11-03
Onset:2010-11-05
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3569BA / 3 LL / UN
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA113AA / 1 LL / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Joint swelling, Urticaria

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? No
Previous Vaccinations:
Other Medications: SINGULAIR - PO - 5mg
Current Illness: No
Preexisting Conditions: NNDA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Urticarial rash, swelling in ankles & wrists.


Changed on 12/30/2020

VAERS ID: 407067 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Alabama
Vaccinated:2010-11-03
Onset:2010-11-05
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3569BA / 3 LL / UN
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA113AA / 1 LL / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Joint swelling, Urticaria

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? No
Previous Vaccinations:
Other Medications: SINGULAIR - PO - 5mg
Current Illness: No
Preexisting Conditions: NNDA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Urticarial rash, swelling in ankles & wrists.


Changed on 5/7/2021

VAERS ID: 407067 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Alabama
Vaccinated:2010-11-03
Onset:2010-11-05
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3569BA / 3 LL / UN
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA113AA / 1 LL / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Joint swelling, Urticaria

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? No
Previous Vaccinations:
Other Medications: SINGULAIR - PO - 5mg
Current Illness: No
Preexisting Conditions: NNDA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Urticarial rash, swelling in ankles & wrists.


Changed on 5/21/2021

VAERS ID: 407067 Before After
VAERS Form:1
Age:12.0
Sex:Female
Location:Alabama
Vaccinated:2010-11-03
Onset:2010-11-05
Submitted:2010-11-05
Entered:2010-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT3569BA / 3 LL / UN
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA113AA / 1 LL / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Joint swelling, Urticaria

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? No
Previous Vaccinations:
Other Medications: SINGULAIR - PO - 5mg
Current Illness: No
Preexisting Conditions: NNDA
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Urticarial rash, swelling in ankles & wrists.

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