|
VAERS ID: |
265372 (history) |
Form: |
Version 1.0 |
Age: |
24.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 2006-10-06 |
Onset: | 2006-10-06 |
Days after vaccination: | 0 |
Submitted: |
2006-10-23 |
Days after onset: | 17 |
Entered: |
2006-10-26 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
- / UNK |
UN / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Eye swelling,
Pruritus,
Vision blurred SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: UNK Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: WAES0610USA09738
Write-up: Information has been received from a physician concerning a 24 year old female pt with no known allergies or reportable medical history who on 10/6/06 was vaccinated IM with a 0.5ml dose of HPV. Several hours later, on 10/6/06 the pt called the office with complaints of swollen puffy eyes, some itching but no rash and blurry vision. The pt was seen in the office that evening on 10/6/06 and was given a dose of Benadryl and was sent home. The pt took a nap for the blurry vision and upon awakening the next morning the pt fully recovered. Blurry vision was considered to be disabling according to the physician since the pt was unable to perform her normal task. Additional information has been requested. |
|
VAERS ID: |
265384 (history) |
Form: |
Version 1.0 |
Age: |
22.0 |
Sex: |
Female |
Location: |
New York |
Vaccinated: | 2006-10-23 |
Onset: | 2006-10-23 |
Days after vaccination: | 0 |
Submitted: |
2006-10-23 |
Days after onset: | 0 |
Entered: |
2006-10-26 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0966P / UNK |
- / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Asthenia,
Dizziness,
Hyperhidrosis,
Syncope vasovagal SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Few minutes after receiving Gardasil vaccine patient had vaso vagal type reaction, weak, dizzy, hot, sweaty. Felt like she was going to faint. |
|
VAERS ID: |
265435 (history) |
Form: |
Version 1.0 |
Age: |
22.0 |
Sex: |
Female |
Location: |
Pennsylvania |
Vaccinated: | 2006-10-17 |
Onset: | 2006-10-17 |
Days after vaccination: | 0 |
Submitted: |
2006-10-26 |
Days after onset: | 9 |
Entered: |
2006-10-26 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0641F / 1 |
RA / - |
Administered by: Private Purchased by: Unknown Symptoms: Acne SMQs:
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: NONE CDC Split Type:
Write-up: Papules used BENADRYL and cortisone. Pt experienced severe case of hives over torso and legs ankle and feet. Hives lasted 4 days. Pt was given BENADRYL. |
|
VAERS ID: |
265676 (history) |
Form: |
Version 1.0 |
Age: |
19.0 |
Sex: |
Female |
Location: |
North Carolina |
Vaccinated: | 2006-10-17 |
Onset: | 2006-10-22 |
Days after vaccination: | 5 |
Submitted: |
2006-10-26 |
Days after onset: | 4 |
Entered: |
2006-10-31 |
Days after submission: | 5 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0955F / 1 |
RA / IM |
Administered by: Private Purchased by: Private Symptoms: Anxiety,
Cough,
Hypersensitivity,
Hypoaesthesia,
Paraesthesia,
Psychomotor hyperactivity,
Pyrexia SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: Thyroid, Potassium levels done. Given flu vaccine 10/27/06 CDC Split Type:
Write-up: Fever, cough, numb, and tingling all over, acted hyperactive loopy, taking OTC cold remedies, MD suggested Claritin and nasal spray for allergies, may need anti anxiety and anti depressant for ADHD, anxiety. |
|
VAERS ID: |
265756 (history) |
Form: |
Version 1.0 |
Age: |
21.0 |
Sex: |
Female |
Location: |
Missouri |
Vaccinated: | 2006-08-01 |
Onset: | 2006-08-03 |
Days after vaccination: | 2 |
Submitted: |
2006-11-01 |
Days after onset: | 90 |
Entered: |
2006-11-01 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0702F / 1 |
LA / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Hypoaesthesia SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Doxycycline,Zoloft,Yasmin Current Illness: none Preexisting Conditions: Depression & Anxiety, Migraine Headaches, Acne, Exzema, Seasonal Allergies. Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Patient complained of Left arm numbness after receiving injection. Lasted less than 48 hours. |
|
VAERS ID: |
265801 (history) |
Form: |
Version 1.0 |
Age: |
16.0 |
Sex: |
Female |
Location: |
Washington |
Vaccinated: | 2006-10-25 |
Onset: | 2006-10-25 |
Days after vaccination: | 0 |
Submitted: |
2006-10-26 |
Days after onset: | 1 |
Entered: |
2006-11-01 |
Days after submission: | 6 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
- / 2 |
LA / - |
Administered by: Private Purchased by: Unknown Symptoms: Vomiting SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Patient reports she vomited 1 time approximately 4 hours following injection of Gardasil. Patient''s mother reports that the patient vomited following the first injection in series. |
|
VAERS ID: |
265808 (history) |
Form: |
Version 1.0 |
Age: |
21.0 |
Sex: |
Female |
Location: |
Maryland |
Vaccinated: | 2006-10-06 |
Onset: | 2006-10-07 |
Days after vaccination: | 1 |
Submitted: |
2006-10-30 |
Days after onset: | 23 |
Entered: |
2006-11-01 |
Days after submission: | 2 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0800F / 1 |
LA / IM |
Administered by: Private Purchased by: Private Symptoms: Chills,
Nausea,
Pyrexia,
Vomiting SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Estrostep Current Illness: NONE Preexisting Conditions: allergic to Penicillin. Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Nausea and vomiting, fever 99 degrees F- 100 degrees F, chills for 3 days. |
|
VAERS ID: |
265839 (history) |
Form: |
Version 1.0 |
Age: |
17.0 |
Sex: |
Female |
Location: |
Ohio |
Vaccinated: | 2006-09-20 |
Onset: | 2006-10-09 |
Days after vaccination: | 19 |
Submitted: |
2006-10-30 |
Days after onset: | 21 |
Entered: |
2006-11-02 |
Days after submission: | 3 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0954F / 1 |
UN / UN |
Administered by: Other Purchased by: Other Symptoms: Asthenia,
Hypoaesthesia SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations: Other Medications: UNK Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: 12/12/06-records received-EMG study on 10/10/2006: nerve conduction studies of right peroneal and tibila nerves were normal. F wave latencies were normal but some blocking was present. Conclusion: study consistent with mild Guillain Barre Syndrome. Glucose on 9/30/06 148, albumin 30, CK 30. CDC Split Type: WAES0610USA11542
Write-up: Information has been received from a physician concerning a 16 year old female who on an unspecified date was vaccinated with the first dose of HPV vaccine. subsequently the pt developed lower extremity weakness and was hospitalized for two days with Guillain [[name]]. The pt received treatment with gamma globulin during her hospitalization. At the time of this report, the pt was back to school and was 99% recovered having only some area of numbness to her lower extremities. The physician did not believe that the pt was on any other medications at the time and had no further details to provide. Additional information has been requested. Mild Guillane [[name]] Syndrome. EMG study on 10/10/2006: nerve conduction studies of right peroneal and tibial nerves were normal. F wave latencies were normal but some blocking was present. Conclusion: study consistent with mild Guillain [[name]] Syndrome. 12/12/06-records received from facility. DX Mild Guillain [[name]] Syndrome. 12/28/06-DC Summary received DC DX: Mild Guillain [[name]] Syndrome. 1.5 week duration of tingling below kness and above ankle bilaterally. Pain with walking. Office note for DO 12/28/06 from pediatric neurologist:continues to have tingling from elbow to hands, improving. On Neurontin 100 mg tabs 1 three times per day. Has pain across shoulders and neck also lower back. Will order labs. |
|
VAERS ID: |
265955 (history) |
Form: |
Version 1.0 |
Age: |
13.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 2006-10-21 |
Onset: | 2006-10-21 |
Days after vaccination: | 0 |
Submitted: |
0000-00-00 |
Entered: |
2006-11-03 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
- / UNK |
UN / - |
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. |
- / 2 |
RA / SC |
Administered by: Private Purchased by: Private Symptoms: Hypoaesthesia,
Injection site pain,
Syncope SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Per pt arm where Gardasil was administered felt painful then numb and then pt fainted for a few seconds. |
|
VAERS ID: |
266325 (history) |
Form: |
Version 1.0 |
Age: |
21.0 |
Sex: |
Female |
Location: |
West Virginia |
Vaccinated: | 2006-08-30 |
Onset: | 2006-08-30 |
Days after vaccination: | 0 |
Submitted: |
2006-11-01 |
Days after onset: | 63 |
Entered: |
2006-11-08 |
Days after submission: | 7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0696F / 1 |
RA / - |
Administered by: Private Purchased by: Private Symptoms: Pain SMQs:
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: NONE CDC Split Type:
Write-up: Complaints of pain in right arm initially after 1st Gardasil injection. States right arm hurt for 1 month after shot was given. |
|