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Found 102 cases where Location is Texas and Vaccine is HPV or HPV2 or HPV4 and Serious

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VAERS ID: 413440 (history)  
Form: Version 1.0  
Age: 17.0  
Sex: Female  
Location: Texas  
Vaccinated:2010-11-08
Onset:2010-11-08
   Days after vaccination:0
Submitted: 2010-12-20
   Days after onset:42
Entered: 2010-12-22
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0768Z / 1 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Asthenia, Bone scan abnormal, Complex regional pain syndrome, Computerised tomogram abnormal, Dysphagia, Dyspnoea, Joint effusion, Muscle atrophy, Nuclear magnetic resonance imaging abnormal, Pain in extremity, Streptococcal infection, Streptococcus test positive, Walking aid user, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Osteonecrosis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NECON
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: magnetic resonance, 11/09?/10, Fluid on the patient''s hip; computed axial, 11/09?/10, Fluid on the patient''s hip; bone scan, 11/09?/10, Fluid on the patient''s hip; diagnostic laboratory, 11/08?/10, Positive for a strep infection; WBC count, 11/08?/10, Elevated
CDC Split Type: WAES1012USA01863

Write-up: Information has been received from a physician and from a licensed practical nurse concerning a 17 year old female patient with no pertinent medical history and no drug reactions or allergies who on 08-NOV-2010, was vaccinated IM with the first 0.5 ml dose of GARDASIL (Lot# 666597/0768Z, expire date 17-OCT-2012). Concomitant medication included NECON. The patient did not receive any concomitant vaccination at that time. The nurse stated that on 08-NOV-2010, sometime after the patient had received the GARDASIL, the patient complained of difficulty breathing and was unable to swallow. The patient was seen in the emergency room. It was reported that the patient was positive for a strep infection (not specified). The patient''s white blood cell (WBC) count was elevated. The patient was treated with a penicillin shot and was sent home and was not admitted to the hospital. Approximately twelve hours later on 09-NOV-2010, the patient experienced left leg pain (also reported as bilateral lower extremity pain) and weakness on. The patient was seen in the hospital and was admitted. The patient was hospitalized on 09-NOV-2010. The patient had a magnetic resonance imaging (MRI), computed axial tomography (CT) scan and a bone scan. The tests revealed fluid on the patient''s hip. The patient was diagnosed with chronic regional pain syndrome. The patient was treated with extensive physical therapy. The patient was discharged on 14-NOV-2010 on NEURONTIN, amitriptyline hydrochloride and hydrocodone. The patient was now recovering but still had persistent pain and required a walker for ambulate due to muscular atrophy. The GARDASIL series had been discontinued. Chronic regional pain syndrome and the patient require a walker to ambulate due to muscular was considered by a physician to be disabling. Additional information has been requested.


VAERS ID: 415253 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: Texas  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2011-01-21
Entered: 2011-01-24
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1101USA01378

Write-up: Information has been received from a physician concerning a 15 year old female patient he heard about (it was unknown if this was a patient of a clinical colleague or an acquaintance of him), that "was healthy as a horse" who on an unspecified date was vaccinated with GARDASIL (it is unknown which dose this was in the series). The physician reported that "within two weeks of administration of the vaccine she is in the hospital with seizures and is a picture of death". At the time of the report, the patient had not recovered. The patient''s symptoms were considered to be disabling and immediately life-threatening by the physician. No further information is available.


VAERS ID: 423875 (history)  
Form: Version 1.0  
Age: 24.0  
Sex: Female  
Location: Texas  
Vaccinated:2010-09-24
Onset:2011-04-08
   Days after vaccination:196
Submitted: 2011-05-24
   Days after onset:46
Entered: 2011-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0331Z / 2 RA / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Anaemia of chronic disease, Anti-SS-A antibody positive, Anti-SS-B antibody positive, Antibody test positive, Antinuclear antibody positive, Biopsy kidney abnormal, Blood iron abnormal, Blood pressure increased, Catheter placement, Catheter site haemorrhage, Computerised tomogram head, Computerised tomogram normal, Demyelinating polyneuropathy, Dialysis, Double stranded DNA antibody positive, Electromyogram abnormal, Gait disturbance, Gastroenteritis, Glomerulonephritis acute, Glomerulonephritis membranous, Guillain-Barre syndrome, Haemodialysis, Haemoglobin decreased, Haemorrhage, Haemorrhagic anaemia, Hypertension, Hypertriglyceridaemia, Hypoaesthesia, Imaging procedure, Immunoglobulin therapy, Lumbar puncture normal, Lupus nephritis, Muscular weakness, Nerve conduction studies abnormal, Nuclear magnetic resonance imaging normal, Nuclear magnetic resonance imaging spinal cord abnormal, Paraesthesia, Post procedural complication, Renal failure acute, Renal haematoma, Renal tubular disorder, Retroperitoneal haematoma, Serum ferritin increased, Somatosensory evoked potentials abnormal, Systemic lupus erythematosus, Vital capacity
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Dyslipidaemia (narrow), Haematopoietic erythropenia (broad), Peripheral neuropathy (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalopathy/delirium (broad), Hypertension (narrow), Demyelination (narrow), Vasculitis (broad), Lipodystrophy (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (broad), Tumour lysis syndrome (broad), Tubulointerstitial diseases (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (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? Yes, 34 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Pt received HPV vaccine 5/13/2010 13174 5-30-11 9/24/2010 03317 11-20-12
Current Illness: Pt received vaccine 5/13/2010 and 9/24/2010 none
Preexisting Conditions: HTN, migraines
Allergies:
Diagnostic Lab Data: see above. Pt has positive paraneoplastic Ab positive test. All imaging studies and neoplasm workup have been negative to date. Pt has not made significant improvements
CDC Split Type:

Write-up: SLE diagnosed 10/2010 months ago admitted with progressive weakness, numbness, and tingling in her lower extremities for last 2 weeks prior to admission. 1. Acute infective demyelinating polyneuropathy, likely Guillain-Barre syndrome. Patient gave a history of progressive weakness, numbness, and tingling following a bout of gastroenteritis. She stated that her symptoms had gotten progressively worse for 2 weeks and was having difficulty with walking. Extensive workup including MRI, CT scan, as well as lumbar puncture. A lumbar puncture did not show any evidence of infection. MRI showed no evidence of infarction. CT brain was negative. MRI of the spine showed abnormal thickening and enhancement of the ventral and dorsal cauda equina nerve roots, likely compatible with Guillain-Barre syndrome. Patient was started on 5 doses IVIG therapy with the last dose on 4/22/2011. EMG and nerve conduction studies on 4/15, and the EP findings were consistent with acute severe infective demyelinating polyneuropathy consistent with possible Guillain-Barre syndrome. Patient never had any plasmapheresis done. Started on Solu-Medrol, which was later changed to prednisone. Her FVC was maintained at greater than 2 L always, and it was checked every shift. Patient still continues to have some lower extremity weakness. To TIRR for therapies 2. Acute renal failure, likely secondary to lupus nephritis. During the hospital course, she was noted to have acute renal failure around 4/17/2011. Her kidney function worsened, and she underwent a renal biopsy on 4/20/2011, which showed class 5 membranous acute glomerulonephritis consistent with lupus nephritis, as well as marked acute tubular injury. Patient was started on dialysis, and she later had a Perm-A-Cath placed and continues to be on hemodialysis. 3. Acute blood loss anemia, likely secondary to retroperitoneal hematoma from Bipsy site plus bleeding from femoral catheter site after removal plus anemia of chronic disease, given iron study showing elevated ferritin. Following the kidney biopsy, patient was noted to have a significant drop in hemoglobin. She was noted to have developed right renal hematoma, for which she was managed symptomatically. Also, she had iron studies, which showed elevated ferritin consistent with anemia of chronic disease, and renal is on board for the same. 4. SLE. Patient was diagnosed with SLE about 6 months ago, and her anti-ANA, anti-Smith/anti-RNP, as well as anti-double stranded DNA along with anti-SSA/anti-SSB antibody positive. Rheumatology has been on board throughout the hospitalization, and her hydroxychloroquine was continued. Solu-Medrol was later changed to prednisone as per rheumatology recommendations, and patient will continue prednisone 60 mg daily, and rheumatology will see her at TIRR and adjust dose accordingly. Patient has not been restarted on CellCept, which was held given her worsening renal function. Rheumatology will follow up at TIRR regarding the same. 7. Hypertriglyceride:pt started on niacin 8. Hypertension. blood pressures were noted to be elevated and placed on Norvasc and appear to be better controlled now.


VAERS ID: 427631 (history)  
Form: Version 1.0  
Age: 19.0  
Sex: Female  
Location: Texas  
Vaccinated:2011-07-15
Onset:2011-07-17
   Days after vaccination:2
Submitted: 2011-07-18
   Days after onset:1
Entered: 2011-07-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1570Z / UNK UN / IM

Administered by: Private       Purchased by: Private
Symptoms: Dyskinesia
SMQs:, Neuroleptic malignant syndrome (broad), Dyskinesia (narrow), Noninfectious encephalopathy/delirium (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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Depakote; Valproic acid; ZOLOFT; Hydroxyzine
Current Illness: Bipolar disorder symptoms
Preexisting Conditions: Anxiety; Depression; Bipolar disorder
Allergies:
Diagnostic Lab Data: Referred to neurologist
CDC Split Type:

Write-up: Spastic spontaneous involuntary movements of limbs, mainly (L) arm but randomly other limbs, (R) arm more than legs.


VAERS ID: 428606 (history)  
Form: Version 1.0  
Age: 11.0  
Sex: Male  
Location: Texas  
Vaccinated:2011-07-18
Onset:2011-07-20
   Days after vaccination:2
Submitted: 2011-08-02
   Days after onset:13
Entered: 2011-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0636AA / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4000AA / 1 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U3979DA / 6 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Malaise, Type 1 diabetes mellitus
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Child became ill 2 days after vaccinations. He was diagnosed 12 days later with new onset Type 1 DM.


VAERS ID: 442843 (history)  
Form: Version 1.0  
Age: 11.0  
Sex: Female  
Location: Texas  
Vaccinated:2009-09-29
Onset:2009-10-06
   Days after vaccination:7
Submitted: 2011-11-16
   Days after onset:771
Entered: 2011-11-17
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0100Y / 1 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Migraine
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PERIACTIN
Current Illness:
Preexisting Conditions: Lyme disease
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1107USA03591

Write-up: Information has been received from a physician concerning a 11 year old female patient with a history of positive for lyme disease who on 29-SEP-2009, was vaccinated with the first dose of GARDASIL (lot # 562300/0100Y, expiration date: 19-APR-2011) (dose and site of administration not reported) and in December 2009, the patient was vaccinated with the second dose of GARDASIL (lot number, dose and site of administration not reported). Concomitant therapy included cyproheptadine hydrochloride and diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid vaccine. On unspecified date, the patient started experiencing migraines after GARDASIL administration which then subsided after a month and came back after a second dose in December 2009. The patient sought unspecified medical attention. No treatment was given for the treatment of the adverse event. At the time of the report, the patient had not recovered. Follow up information has been received from a health care professional concerning the female student patient with no pre-existing allergies, birth defects, medical conditions or illness at time of vaccination who on 01-DEC-2009, at 16:03, was vaccinated intramuscularly with the second dose of GARDASIL (lot number: 662724/0313Y). On 06-OCT-2009, at 14:57, the patient experienced migraines. At the time of this report, migraines were ongoing. Laboratories and a computed axial tomography were recommended. The patient was also referred with a neurologist. The patient sought unspecified medical attention. Migraines were considered to be disabling by the reporter. Additional information has been requested.


VAERS ID: 443714 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: Texas  
Vaccinated:2011-01-20
Onset:2011-03-01
   Days after vaccination:40
Submitted: 2011-11-28
   Days after onset:272
Entered: 2011-11-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0664Z / 1 UN / UN

Administered by: Unknown       Purchased by: Military
Symptoms: Amenorrhoea, Smear cervix, Ultrasound scan
SMQs:, Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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:
CDC Split Type:

Write-up: My daughter was given the Gardasil shot this year, she has stopped her period completely and has not recovered it. She had the last shot in October of 2011 and still no period so I got concerned and took her two different Dr.''s. My daughter has has two ultrasounds and a pap smear to see what is going on. I have her going to an actual OB/GYN and having her seen and see if there is a way to force her period other than medicines, we already have tried that. My daughter had healthy periods and was regular till she received the shot and I am upset and concerned because it wasn''t written as a side affect. I have did research online and my daughter is not the only one, there are a number of females that has experienced the same thing and are also concerned.


VAERS ID: 445408 (history)  
Form: Version 1.0  
Age: 19.0  
Sex: Female  
Location: Texas  
Vaccinated:2011-11-28
Onset:2011-11-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2011-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0476AA / 1 LA / SC
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3540AA / 1 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Capnogram normal, Chest pain, Cyanosis, Dyspnoea, End-tidal CO2 increased, Endotracheal intubation, Fatigue, Intensive care, Pharyngeal oedema, Stridor
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None reported
Preexisting Conditions: Client states allergies to bananas, tomatoes, most fruits. States her throat swells when she eats them but she still eats them occasionally.
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: App. 4:10 p.m., client returned to clinic c/o shortness of breath and chest pain. A coarse, respiratory stridor was audible during conversation. Client was taken to lab room and seated. Per protocol, .3 cc of epinephrine 1:1000 was administered, S.Q. Immediately following, Diphenhydramine (50 mg/ml) 1 ml. was administered IM, after no improvement was noted, 911 was called. Patient drove herself several blocks back to clinic from college approx 30 min after receiving first dose each of MCV4 and HPV vaccines. Moderate distress and coarse inspiratory stridor was observed while speaking and accompanied reports of shortness of breath, feeling of throat swelling and chest pain. Pt. remained conscious and coherent without signs of rash, cyanosis or expiratory delay throughout treatment with 0.3 cc of 1:1000 EPI times 2 doses followed by BENADRYL 50 mg IM. EMS was called via 911 when symptoms failed to improve. Pulse ox showed SAO2 was 99 or 100 on each recording. She was given O2, ATROVENT neb and SOLUMEDROL again without significant improvement in complaints. End tidal CO2 remained ~33 and capnogram waveform was not suggestive of bronchospasm. She was then transported non-emergently by EMS to ED. Physician confirmed previous findings on arrival and described her breathing as "almost stridor". Therapeutic trials of RACEMIC and IV EPI and albuterol also did not relieve symptoms. Pt did not become cyanotic or fatigued but continued complaints of difficulty breathing prompted Anesthesia consult. As a precaution and in order to gain control of her airway she was sedated with Propophol and intubated. Patient remained in ICU over night and extubated the following morning. Extubation was followed by resumption of similar symptoms which were managed with VALIUM. Patient was discharged to home the following morning.


VAERS ID: 447576 (history)  
Form: Version 1.0  
Age: 11.0  
Sex: Female  
Location: Texas  
Vaccinated:2012-01-16
Onset:2012-01-16
   Days after vaccination:0
Submitted: 2012-01-18
   Days after onset:2
Entered: 2012-01-19
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1291AA / 2 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Anaphylactic reaction, Dyspnoea, Lip oedema, Rash, Tongue oedema
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal allergic conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Allergic rhinitis; wheeze
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received HPV #2. 3 hours later, pt started have difficulty breathing, rash; lip & tongue edema. Seen at ER for anaphylaxis. S/P epinephrine, methylprednisolone, and diphenhydramine. D/C home on oral prednisone and EPIPEN.


VAERS ID: 449831 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: Texas  
Vaccinated:2011-11-15
Onset:2011-12-30
   Days after vaccination:45
Submitted: 2012-02-13
   Days after onset:45
Entered: 2012-02-20
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0692AA / 1 RA / UN

Administered by: Private       Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: None stated.


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