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This is VAERS ID 421086

History of Changes from the VAERS Wayback Machine

First Appeared on 5/13/2011

421086
VAERS Form:
Age:12.0
Gender:Female
Location:Foreign
Vaccinated:2011-03-14
Onset:2011-03-15
Submitted:2011-04-13
Entered:2011-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. NJ28270 / 0 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Blood albumin decreased, Rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Serum albumin, nil
CDC 'Split Type': WAES1104USA01093

Write-up:Information was obtained on a request by the Company from the agency via a Public Case Detail form concerning a 12 year old female patient who on 14-MAR-2011 was vaccinated with first dose of GARDASIL (batch# NK 19970, lot# NJ28270) 0.5ML IM. On unspecified date, the lab results showed albumin nil. On 15-MAR-2011, the patient developed a light rash on the torso only (none on arms/legs/face), and some vague pain in abdomen. The patient was treated with PANADOL, dose for age on 15-MAR-2011 only. On 16-MAR-2011, the rash had gone. The patient was well. It was considered the events was possibly related to GARDASIL. The rash and abdominal pain were considered as incapacity/disability. The original reporting source was not provided. No further information is available.


Changed on 6/14/2014

421086 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Foreign
Vaccinated:2011-03-14
Onset:2011-03-15
Submitted:2011-04-13
Entered:2011-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. NJ28270 / 0 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Blood albumin decreased, Rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Serum albumin, nil
CDC 'Split Type': WAES1104USA01093

Write-up:Information was obtained on a request by the Company from the agency via a Public Case Detail form concerning a 12 year old female patient who on 14-MAR-2011 was vaccinated with first dose of GARDASIL (batch# NK 19970, lot# NJ28270) 0.5ML IM. On unspecified date, the lab results showed albumin nil. On 15-MAR-2011, the patient developed a light rash on the torso only (none on arms/legs/face), and some vague pain in abdomen. The patient was treated with PANADOL, dose for age on 15-MAR-2011 only. On 16-MAR-2011, the rash had gone. The patient was well. It was considered the events was possibly related to GARDASIL. The rash and abdominal pain were considered as incapacity/disability. The original reporting source was not provided. No further information is available.


Changed on 4/14/2017

421086 Before After
VAERS Form:
Age:12.0
Gender:Female
Location:Foreign
Vaccinated:2011-03-14
Onset:2011-03-15
Submitted:2011-04-13
Entered:2011-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. NJ28270 / 0 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Blood albumin decreased, Rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Serum albumin, nil
CDC 'Split Type': WAES1104USA01093

Write-up:Information was obtained on a request by the Company from the agency via a Public Case Detail form concerning a 12 year old female patient who on 14-MAR-2011 was vaccinated with first dose of GARDASIL (batch# NK 19970, lot# NJ28270) 0.5ML IM. On unspecified date, the lab results showed albumin nil. On 15-MAR-2011, the patient developed a light rash on the torso only (none on arms/legs/face), and some vague pain in abdomen. The patient was treated with PANADOL, dose for age on 15-MAR-2011 only. On 16-MAR-2011, the rash had gone. The patient was well. It was considered the events was possibly related to GARDASIL. The rash and abdominal pain were considered as incapacity/disability. The original reporting source was not provided. No further information is available.


Changed on 9/14/2017

421086 Before After
VAERS Form:(blank) 1
Age:12.0
Gender:Female
Location:Foreign
Vaccinated:2011-03-14
Onset:2011-03-15
Submitted:2011-04-13
Entered:2011-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. NJ28270 / 0 1 UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Blood albumin decreased, Rash

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Serum albumin, nil
CDC 'Split Type': WAES1104USA01093

Write-up:Information was obtained on a request by the Company from the agency via a Public Case Detail form concerning a 12 year old female patient who on 14-MAR-2011 was vaccinated with first dose of GARDASIL (batch# NK 19970, lot# NJ28270) 0.5ML IM. On unspecified date, the lab results showed albumin nil. On 15-MAR-2011, the patient developed a light rash on the torso only (none on arms/legs/face), and some vague pain in abdomen. The patient was treated with PANADOL, dose for age on 15-MAR-2011 only. On 16-MAR-2011, the rash had gone. The patient was well. It was considered the events was possibly related to GARDASIL. The rash and abdominal pain were considered as incapacity/disability. The original reporting source was not provided. No further information is available.


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