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This is VAERS ID 267997

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

267997
VAERS Form:
Age:15.0
Gender:Female
Location:New Jersey
Vaccinated:2006-09-22
Onset:2006-09-23
Submitted:2006-11-29
Entered:2006-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0800F / 0 LA / -

Administered by: Private      Purchased by: Unknown
Symptoms: Arrhythmia, Chest X-ray normal, Computerised tomogram normal, Confusional state, Disorientation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Insulin
Current Illness:
Preexisting Conditions: Type 1 Diabetes
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: EKG shows sinus arythmia, Drug and pregnancy screens (-), other labs WNL including serum glucose, CXR-normal, head CT-(-). Labs and Diagnostics: UA significant for $g1000mg/dl glucose and 40 ketones. HgbA1C 8.8, oth
CDC 'Split Type':

Write-up:Patient awoke morning after vaccination with grand mal seizure. Her mother took her to a local hospital and she was transferred to another hospital and then to another.


Changed on 12/8/2009

267997 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:New Jersey
Vaccinated:2006-09-22
Onset:2006-09-23
Submitted:2006-11-29
Entered:2006-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. 0800F / 0 LA / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Arrhythmia, Chest X-ray normal, Computerised tomogram normal, Confusional state, Disorientation, Electrocardiogram, Glucose urine present, Glycosylated haemoglobin increased, Grand mal convulsion, Hypoglycaemia, Pregnancy test negative, Urine analysis, Mental status changes, Drug screen negative, Urine ketone body present, Dysmorphism

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Insulin Meds: Lantus insulin and Novolog.
Current Illness:
Preexisting Conditions: Type 1 Diabetes Diabetes. NKDA
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: EKG shows sinus arythmia, Drug and pregnancy screens (-), other labs WNL including serum glucose, CXR-normal, head CT-(-). Labs and Diagnostics: UA significant for $g1000mg/dl glucose and 40 ketones. HgbA1C 8.8, oth
CDC 'Split Type':

Write-up:Patient awoke morning after vaccination with grand mal seizure. Her mother took her to a local hospital and she was transferred to another hospital and then to another. MR received from 1st ER visit which reveals a 15 yr old brought in by her mother with c/o confusion, disorientation, and facial distortion on the morning following her Gardasil vax. PE: Significant for confusion and disorientation, otherwise normal. Patient was transfered to another hospital to be followed by a pediatric neurologist, Clinical impression : Altered mental status. MR received from 2nd hospital. Pt. transfered to PICU with a diagnosis of altered mental status. Still somewhat confused but improving upon admission. Improvement in mental status over the next 24 hours and she was transfered to a regular pediatric floor, oriented x3 and with no focal deficits. Discharge DX: New onset seizures (probably 2'' to hypoglycemia per face sheet).


Changed on 8/31/2010

267997 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:New Jersey
Vaccinated:2006-09-22
Onset:2006-09-23
Submitted:2006-11-29
Entered:2006-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0800F / 0 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Arrhythmia, Chest X-ray normal, Computerised tomogram normal, Confusional state, Disorientation, Electrocardiogram, Glucose urine present, Glycosylated haemoglobin increased, Grand mal convulsion, Hypoglycaemia, Pregnancy test negative, Urine analysis, Mental status changes, Drug screen negative, Urine ketone body present, Dysmorphism

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Insulin Meds: Lantus insulin and Novolog.
Current Illness:
Preexisting Conditions: Type 1 Diabetes. NKDA
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: EKG shows sinus arythmia, Drug and pregnancy screens (-), other labs WNL including serum glucose, CXR-normal, head CT-(-). Labs and Diagnostics: UA significant for $g1000mg/dl glucose and 40 ketones. HgbA1C 8.8, oth
CDC 'Split Type':

Write-up:Patient awoke morning after vaccination with grand mal seizure. Her mother took her to a local hospital and she was transferred to another hospital and then to another. MR received from 1st ER visit which reveals a 15 yr old brought in by her mother with c/o confusion, disorientation, and facial distortion on the morning following her Gardasil vax. PE: Significant for confusion and disorientation, otherwise normal. Patient was transfered to another hospital to be followed by a pediatric neurologist, Clinical impression : Altered mental status. MR received from 2nd hospital. Pt. transfered to PICU with a diagnosis of altered mental status. Still somewhat confused but improving upon admission. Improvement in mental status over the next 24 hours and she was transfered to a regular pediatric floor, oriented x3 and with no focal deficits. Discharge DX: New onset seizures (probably 2'' to hypoglycemia per face sheet).


Changed on 4/13/2011

267997 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:New Jersey
Vaccinated:2006-09-22
Onset:2006-09-23
Submitted:2006-11-29
Entered:2006-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0800F / 0 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Arrhythmia, Chest X-ray normal, Computerised tomogram normal, Confusional state, Disorientation, Electrocardiogram, Glucose urine present, Glycosylated haemoglobin increased, Grand mal convulsion, Hypoglycaemia, Pregnancy test negative, Urine analysis, Mental status changes, Drug screen negative, Urine ketone body present, Dysmorphism

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Insulin Meds: Lantus insulin and Novolog.
Current Illness:
Preexisting Conditions: Type 1 Diabetes. NKDA
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: EKG shows sinus arythmia, Drug and pregnancy screens (-), other labs WNL including serum glucose, CXR-normal, head CT-(-). Labs and Diagnostics: UA significant for $g1000mg/dl glucose and 40 ketones. HgbA1C 8.8, oth
CDC 'Split Type':

Write-up:Patient awoke morning after vaccination with grand mal seizure. Her mother took her to a local hospital and she was transferred to another hospital and then to another. MR received from 1st ER visit which reveals a 15 yr old brought in by her mother with c/o confusion, disorientation, and facial distortion on the morning following her Gardasil vax. PE: Significant for confusion and disorientation, otherwise normal. Patient was transfered to another hospital to be followed by a pediatric neurologist, Clinical impression : Altered mental status. MR received from 2nd hospital. Pt. transfered to PICU with a diagnosis of altered mental status. Still somewhat confused but improving upon admission. Improvement in mental status over the next 24 hours and she was transfered to a regular pediatric floor, oriented x3 and with no focal deficits. Discharge DX: New onset seizures (probably 2'' to hypoglycemia per face sheet).


Changed on 5/13/2011

267997 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:New Jersey
Vaccinated:2006-09-22
Onset:2006-09-23
Submitted:2006-11-29
Entered:2006-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0800F / 0 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Arrhythmia, Chest X-ray normal, Computerised tomogram normal, Confusional state, Disorientation, Electrocardiogram, Glucose urine present, Glycosylated haemoglobin increased, Grand mal convulsion, Hypoglycaemia, Pregnancy test negative, Urine analysis, Mental status changes, Drug screen negative, Urine ketone body present, Dysmorphism

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Insulin Meds: Lantus insulin and Novolog.
Current Illness:
Preexisting Conditions: Type 1 Diabetes. NKDA
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: EKG shows sinus arythmia, Drug and pregnancy screens (-), other labs WNL including serum glucose, CXR-normal, head CT-(-). Labs and Diagnostics: UA significant for $g1000mg/dl glucose and 40 ketones. HgbA1C 8.8, oth
CDC 'Split Type':

Write-up:Patient awoke morning after vaccination with grand mal seizure. Her mother took her to a local hospital and she was transferred to another hospital and then to another. MR received from 1st ER visit which reveals a 15 yr old brought in by her mother with c/o confusion, disorientation, and facial distortion on the morning following her Gardasil vax. PE: Significant for confusion and disorientation, otherwise normal. Patient was transfered to another hospital to be followed by a pediatric neurologist, Clinical impression : Altered mental status. MR received from 2nd hospital. Pt. transfered to PICU with a diagnosis of altered mental status. Still somewhat confused but improving upon admission. Improvement in mental status over the next 24 hours and she was transfered to a regular pediatric floor, oriented x3 and with no focal deficits. Discharge DX: New onset seizures (probably 2'' to hypoglycemia per face sheet).


Changed on 6/11/2011

267997 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:New Jersey
Vaccinated:2006-09-22
Onset:2006-09-23
Submitted:2006-11-29
Entered:2006-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0800F / 0 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Arrhythmia, Chest X-ray normal, Computerised tomogram normal, Confusional state, Disorientation, Electrocardiogram, Glucose urine present, Glycosylated haemoglobin increased, Grand mal convulsion, Hypoglycaemia, Pregnancy test negative, Urine analysis, Mental status changes, Drug screen negative, Urine ketone body present, Dysmorphism

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Insulin Meds: Lantus insulin and Novolog.
Current Illness:
Preexisting Conditions: Type 1 Diabetes. NKDA
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: EKG shows sinus arythmia, Drug and pregnancy screens (-), other labs WNL including serum glucose, CXR-normal, head CT-(-). Labs and Diagnostics: UA significant for $g1000mg/dl glucose and 40 ketones. HgbA1C 8.8, oth
CDC 'Split Type':

Write-up:Patient awoke morning after vaccination with grand mal seizure. Her mother took her to a local hospital and she was transferred to another hospital and then to another. MR received from 1st ER visit which reveals a 15 yr old brought in by her mother with c/o confusion, disorientation, and facial distortion on the morning following her Gardasil vax. PE: Significant for confusion and disorientation, otherwise normal. Patient was transfered to another hospital to be followed by a pediatric neurologist, Clinical impression : Altered mental status. MR received from 2nd hospital. Pt. transfered to PICU with a diagnosis of altered mental status. Still somewhat confused but improving upon admission. Improvement in mental status over the next 24 hours and she was transfered to a regular pediatric floor, oriented x3 and with no focal deficits. Discharge DX: New onset seizures (probably 2'' to hypoglycemia per face sheet).


Changed on 5/14/2017

267997 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:New Jersey
Vaccinated:2006-09-22
Onset:2006-09-23
Submitted:2006-11-29
Entered:2006-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0800F / 0 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Arrhythmia, Chest X-ray normal, Computerised tomogram normal, Confusional state, Disorientation, Electrocardiogram, Glucose urine present, Glycosylated haemoglobin increased, Grand mal convulsion, Hypoglycaemia, Pregnancy test negative, Urine analysis, Mental status changes, Drug screen negative, Urine ketone body present, Dysmorphism

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Insulin Meds: Lantus insulin and Novolog.
Current Illness:
Preexisting Conditions: Type 1 Diabetes. NKDA
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: EKG shows sinus arythmia, Drug and pregnancy screens (-), other labs WNL including serum glucose, CXR-normal, head CT-(-). Labs and Diagnostics: UA significant for $g1000mg/dl glucose and 40 ketones. HgbA1C 8.8, oth otherwise unremarkable.
CDC 'Split Type':

Write-up:Patient awoke morning after vaccination with grand mal seizure. Her mother took her to a local hospital and she was transferred to another hospital and then to another. MR received from 1st ER visit which reveals a 15 yr old brought in by her mother with c/o confusion, disorientation, and facial distortion on the morning following her Gardasil vax. PE: Significant for confusion and disorientation, otherwise normal. Patient was transfered to another hospital to be followed by a pediatric neurologist, Clinical impression : Altered mental status. MR received from 2nd hospital. Pt. transfered to PICU with a diagnosis of altered mental status. Still somewhat confused but improving upon admission. Improvement in mental status over the next 24 hours and she was transfered to a regular pediatric floor, oriented x3 and with no focal deficits. Discharge DX: New onset seizures (probably 2'' to hypoglycemia per face sheet).


Changed on 9/14/2017

267997 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:New Jersey
Vaccinated:2006-09-22
Onset:2006-09-23
Submitted:2006-11-29
Entered:2006-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0800F / 0 1 LA / -

Administered by: Private      Purchased by: Private
Symptoms: Grand mal convulsion

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Insulin Meds: Lantus insulin and Novolog.
Current Illness:
Preexisting Conditions: Type 1 Diabetes. NKDA
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: EKG shows sinus arythmia, Drug and pregnancy screens (-), other labs WNL including serum glucose, CXR-normal, head CT-(-). Labs and Diagnostics: UA significant for $g1000mg/dl glucose and 40 ketones. HgbA1C 8.8, otherwise unremarkable.
CDC 'Split Type':

Write-up:Patient awoke morning after vaccination with grand mal seizure. Her mother took her to a local hospital and she was transferred to another hospital and then to another. MR received from 1st ER visit which reveals a 15 yr old brought in by her mother with c/o confusion, disorientation, and facial distortion on the morning following her Gardasil vax. PE: Significant for confusion and disorientation, otherwise normal. Patient was transfered to another hospital to be followed by a pediatric neurologist, Clinical impression : Altered mental status. MR received from 2nd hospital. Pt. transfered to PICU with a diagnosis of altered mental status. Still somewhat confused but improving upon admission. Improvement in mental status over the next 24 hours and she was transfered to a regular pediatric floor, oriented x3 and with no focal deficits. Discharge DX: New onset seizures (probably 2'' to hypoglycemia per face sheet).


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