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This is VAERS ID 567659

History of Changes from the VAERS Wayback Machine

First Appeared on 3/14/2015

567659
VAERS Form:
Age:15.0
Gender:Male
Location:New Jersey
Vaccinated:2012-10-24
Onset:2013-02-09
Submitted:2015-03-02
Entered:2015-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H013831 / 1 RA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Anal ulcer, Surgery, Anal haemorrhage

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:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Patient has had four surgeries to close the ulcer located near his anus. All have been unsucessful.
CDC 'Split Type':

Write-up:Went to have bowel movement and started bleeding profusely from anal area. No prior symptoms.


Changed on 9/14/2017

567659 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Male
Location:New Jersey
Vaccinated:2012-10-24
Onset:2013-02-09
Submitted:2015-03-02
Entered:2015-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H013831 / 1 2 RA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Anal ulcer, Surgery, Anal haemorrhage

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:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Patient has had four surgeries to close the ulcer located near his anus. All have been unsucessful.
CDC 'Split Type':

Write-up:Went to have bowel movement and started bleeding profusely from anal area. No prior symptoms.


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Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=567659&WAYBACKHISTORY=ON


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