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This is VAERS ID 270532

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 270532
Age:13.0
Gender:Female
Location:Florida
Vaccinated:2007-01-03
Onset:2007-01-03
Submitted:2007-01-12
Entered:2007-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Blindness transient, Computerised tomogram normal, Dehydration, Electroencephalogram normal, Drug screen negative

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concerta
Current Illness:
Preexisting Conditions: Penicillin allergy; latex allergy Status post Kawasaki disease two weeks after developing chicken pox, attention deficit/hyperactivity disorder.
Diagnostic Lab Data: CT of brain: normal Urine toxicology normal WBC 6.6, polys 85, lymphocytes 6, monocytes 6, eosinophils 2. Total protein over albumin is 6.9/4.2, calcium 9.2, magnesium 1.9. EEG: normal.
CDC 'Split Type':

Write-up:Information has been received from a physician concerning a 12 year old female with a penicillin allergy and latex allergy who on 03-JAN-2007 was vaccinated intramuscularly with a 0.5 mL first dose of Gardasil. Concomitant therapy included Concerta. Later"that evening, on 03-JAN-2007, the patient developed nausea and vomited once. At approximately 07:00 am on 04-JAN-2007, the patient developed a headache and temporal blindness that lasted approximately 40 seconds. The patient was taken to the emergency roo


Changed on 12/8/2009

VAERS ID: 270532 Before After
Age:13.0 12.0
Gender:Female
Location:Florida
Vaccinated:2007-01-03
Onset:2007-01-03
Submitted:2007-01-12
Entered:2007-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 - UN / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Blindness transient, Computerised tomogram normal, Dehydration, Electroencephalogram normal, Full blood count normal, Headache, Loss of consciousness, Nausea, Pyrexia, Staring, Syncope, Syncope vasovagal, Vomiting, Drug screen negative, Laboratory test normal, Oral intake reduced

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concerta
Current Illness:
Preexisting Conditions: Penicillin allergy; latex allergy Status post Kawasaki disease two weeks after developing chicken pox, attention deficit/hyperactivity disorder.
Diagnostic Lab Data: CT of brain: normal Urine toxicology normal WBC 6.6, polys 85, lymphocytes 6, monocytes 6, eosinophils 2. Total protein over albumin is 6.9/4.2, calcium 9.2, magnesium 1.9. EEG: normal.
CDC 'Split Type': (blank) WAES0701USA00620

Write-up:Information has been received from a physician concerning a 12 year old female with a penicillin allergy and latex allergy who on 03-JAN-2007 was vaccinated intramuscularly with a 0.5 mL first dose of Gardasil. GARDASIL. Concomitant therapy included Concerta. Later"that Later that evening, on 03-JAN-2007, the patient developed nausea and vomited once. At approximately 07:00 am on 04-JAN-2007, the patient developed a headache and temporal blindness that lasted approximately 40 seconds. The patient was taken to the emergency roo room. At 10:03 am, the patient had a second incidence of headache and temporal blindness that also lasted approximately 40 seconds. At the time of this reported, the patient was stable but was to be admitted to the hospital for observation. At the time of this report, the outcome was unknown. Additional information has been requested. 01/22/07-records received and reviewed from West Boca Medical Center for DOS 01/0407-transferred with DX of new onset seizures to Joe DiMaggio''s Children''s Hospital. Records requested. CT brain without contrast: negative exam, recommend MRI. 01/30/07-rcords received for DOS 01/04-01/05/07 DC DX: 1. Vasovagal response secondary to dehydration 2. Syncope secondary to #1. Hospital Course: Transferred from West Boca Med Ctr. Admitted with vomiting decreased oral intake since yesterday, complained of blindness and severe headaches this morning with fever of 101.4. Experienced 35-45 second of complaining of blindness, loss of consciousness and staring episode at West Boca Med Ctr. PMH: Status post Kawasaki disease two weeks after developing chicken pox, attention deficit/hyperactivity disorder.


Changed on 1/7/2013

VAERS ID: 270532 Before After
Age:12.0
Gender:Female
Location:Florida
Vaccinated:2007-01-03
Onset:2007-01-03
Submitted:2007-01-12
Entered:2007-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Blindness transient, Computerised tomogram normal, Dehydration, Electroencephalogram normal, Full blood count normal, Headache, Loss of consciousness, Nausea, Pyrexia, Staring, Syncope, Syncope vasovagal, Vomiting, Drug screen negative, Laboratory test normal, Oral intake reduced

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concerta
Current Illness:
Preexisting Conditions: Penicillin allergy; latex allergy Status post Kawasaki disease two weeks after developing chicken pox, attention deficit/hyperactivity disorder.
Diagnostic Lab Data: CT of brain: normal Urine toxicology normal WBC 6.6, polys 85, lymphocytes 6, monocytes 6, eosinophils 2. Total protein over albumin is 6.9/4.2, calcium 9.2, magnesium 1.9. EEG: normal.
CDC 'Split Type': WAES0701USA00620

Write-up:Information has been received from a physician concerning a 12 year old female with a penicillin allergy and latex allergy who on 03-JAN-2007 was vaccinated intramuscularly with a 0.5 mL first dose of GARDASIL. Concomitant therapy included Concerta. Later that evening, on 03-JAN-2007, the patient developed nausea and vomited once. At approximately 07:00 am on 04-JAN-2007, the patient developed a headache and temporal blindness that lasted approximately 40 seconds. The patient was taken to the emergency room. At 10:03 am, the patient had a second incidence of headache and temporal blindness that also lasted approximately 40 seconds. At the time of this reported, the patient was stable but was to be admitted to the hospital for observation. At the time of this report, the outcome was unknown. Additional information has been requested. 01/22/07-records received and reviewed from West Boca Medical Center for DOS 01/0407-transferred with DX of new onset seizures to Joe DiMaggio''s Children''s another Hospital. Records requested. CT brain without contrast: negative exam, recommend MRI. 01/30/07-rcords received for DOS 01/04-01/05/07 DC DX: 1. Vasovagal response secondary to dehydration 2. Syncope secondary to #1. Hospital Course: Transferred from West Boca Med Ctr. Admitted with vomiting decreased oral intake since yesterday, complained of blindness and severe headaches this morning with fever of 101.4. Experienced 35-45 second of complaining of blindness, loss of consciousness and staring episode at West Boca Med Ctr. PMH: Status post Kawasaki disease two weeks after developing chicken pox, attention deficit/hyperactivity disorder.


Changed on 6/14/2014

VAERS ID: 270532 Before After
Age:12.0
Gender:Female
Location:Florida
Vaccinated:2007-01-03
Onset:2007-01-03
Submitted:2007-01-12
Entered:2007-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Blindness transient, Computerised tomogram normal, Dehydration, Electroencephalogram normal, Full blood count normal, Headache, Loss of consciousness, Nausea, Pyrexia, Staring, Syncope, Syncope vasovagal, Vomiting, Drug screen negative, Laboratory test normal, Oral intake reduced

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concerta
Current Illness:
Preexisting Conditions: Penicillin allergy; latex allergy Status post Kawasaki disease two weeks after developing chicken pox, attention deficit/hyperactivity disorder.
Diagnostic Lab Data: CT of brain: normal Urine toxicology normal WBC 6.6, polys 85, lymphocytes 6, monocytes 6, eosinophils 2. Total protein over albumin is 6.9/4.2, calcium 9.2, magnesium 1.9. EEG: normal.
CDC 'Split Type': WAES0701USA00620

Write-up:Information has been received from a physician concerning a 12 year old female with a penicillin allergy and latex allergy who on 03-JAN-2007 was vaccinated intramuscularly with a 0.5 mL first dose of GARDASIL. Concomitant therapy included Concerta. Later that evening, on 03-JAN-2007, the patient developed nausea and vomited once. At approximately 07:00 am on 04-JAN-2007, the patient developed a headache and temporal blindness that lasted approximately 40 seconds. The patient was taken to the emergency room. At 10:03 am, the patient had a second incidence of headache and temporal blindness that also lasted approximately 40 seconds. At the time of this reported, the patient was stable but was to be admitted to the hospital for observation. At the time of this report, the outcome was unknown. Additional information has been requested. 01/22/07-records received and reviewed from Medical Center for DOS 01/0407-transferred with DX of new onset seizures to another Hospital. Records requested. CT brain without contrast: negative exam, recommend MRI. 01/30/07-rcords received for DOS 01/04-01/05/07 DC DX: 1. Vasovagal response secondary to dehydration 2. Syncope secondary to #1. Hospital Course: Transferred from Med Ctr. Admitted with vomiting decreased oral intake since yesterday, complained of blindness and severe headaches this morning with fever of 101.4. Experienced 35-45 second of complaining of blindness, loss of consciousness and staring episode at Med Ctr. PMH: Status post Kawasaki disease two weeks after developing chicken pox, attention deficit/hyperactivity disorder.


Changed on 3/14/2015

VAERS ID: 270532 Before After
Age:12.0
Gender:Female
Location:Florida
Vaccinated:2007-01-03
Onset:2007-01-03
Submitted:2007-01-12
Entered:2007-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Blindness transient, Computerised tomogram normal, Dehydration, Electroencephalogram normal, Full blood count normal, Headache, Loss of consciousness, Nausea, Pyrexia, Staring, Syncope, Syncope vasovagal, Vomiting, Drug screen negative, Laboratory test normal, Oral intake reduced

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concerta
Current Illness:
Preexisting Conditions: Penicillin allergy; latex allergy Status post Kawasaki disease two weeks after developing chicken pox, attention deficit/hyperactivity disorder.
Diagnostic Lab Data: CT of brain: normal Urine toxicology normal WBC 6.6, polys 85, lymphocytes 6, monocytes 6, eosinophils 2. Total protein over albumin is 6.9/4.2, calcium 9.2, magnesium 1.9. EEG: normal.
CDC 'Split Type': WAES0701USA00620

Write-up:Information has been received from a physician concerning a 12 year old female with a penicillin allergy and latex allergy who on 03-JAN-2007 was vaccinated intramuscularly with a 0.5 mL first dose of GARDASIL. Concomitant therapy included Concerta. Later that evening, on 03-JAN-2007, the patient developed nausea and vomited once. At approximately 07:00 am on 04-JAN-2007, the patient developed a headache and temporal blindness that lasted approximately 40 seconds. The patient was taken to the emergency room. At 10:03 am, the patient had a second incidence of headache and temporal blindness that also lasted approximately 40 seconds. At the time of this reported, the patient was stable but was to be admitted to the hospital for observation. At the time of this report, the outcome was unknown. Additional information has been requested. 01/22/07-records received and reviewed from Medical Center for DOS 01/0407-transferred with DX of new onset seizures to another Hospital. Records requested. CT brain without contrast: negative exam, recommend MRI. 01/30/07-rcords received for DOS 01/04-01/05/07 DC DX: 1. Vasovagal response secondary to dehydration 2. Syncope secondary to #1. Hospital Course: Transferred from Med Ctr. Admitted with vomiting decreased oral intake since yesterday, complained of blindness and severe headaches this morning with fever of 101.4. Experienced 35-45 second of complaining of blindness, loss of consciousness and staring episode at Med Ctr. PMH: Status post Kawasaki disease two weeks after developing chicken pox, attention deficit/hyperactivity disorder.


Changed on 5/14/2017

VAERS ID: 270532 Before After
Age:12.0
Gender:Female
Location:Florida
Vaccinated:2007-01-03
Onset:2007-01-03
Submitted:2007-01-12
Entered:2007-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Blindness transient, Computerised tomogram normal, Dehydration, Electroencephalogram normal, Full blood count normal, Headache, Loss of consciousness, Nausea, Pyrexia, Staring, Syncope, Syncope vasovagal, Vomiting, Drug screen negative, Laboratory test normal, Oral intake reduced

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concerta
Current Illness:
Preexisting Conditions: Penicillin allergy; latex allergy Status post Kawasaki disease two weeks after developing chicken pox, attention deficit/hyperactivity disorder.
Diagnostic Lab Data: CT of brain: normal Urine toxicology normal WBC 6.6, polys 85, lymphocytes 6, monocytes 6, eosinophils 2. Total protein over albumin is 6.9/4.2, calcium 9.2, magnesium 1.9. EEG: normal.
CDC 'Split Type': WAES0701USA00620

Write-up:Information has been received from a physician concerning a 12 year old female with a penicillin allergy and latex allergy who on 03-JAN-2007 was vaccinated intramuscularly with a 0.5 mL first dose of GARDASIL. Concomitant therapy included Concerta. Later that evening, on 03-JAN-2007, the patient developed nausea and vomited once. At approximately 07:00 am on 04-JAN-2007, the patient developed a headache and temporal blindness that lasted approximately 40 seconds. The patient was taken to the emergency room. At 10:03 am, the patient had a second incidence of headache and temporal blindness that also lasted approximately 40 seconds. At the time of this reported, the patient was stable but was to be admitted to the hospital for observation. At the time of this report, the outcome was unknown. Additional information has been requested. 01/22/07-records received and reviewed from Medical Center for DOS 01/0407-transferred with DX of new onset seizures to another Hospital. Records requested. CT brain without contrast: negative exam, recommend MRI. 01/30/07-rcords received for DOS 01/04-01/05/07 DC DX: 1. Vasovagal response secondary to dehydration 2. Syncope secondary to #1. Hospital Course: Transferred from Med Ctr. Admitted with vomiting decreased oral intake since yesterday, complained of blindness and severe headaches this morning with fever of 101.4. Experienced 35-45 second of complaining of blindness, loss of consciousness and staring episode at Med Ctr. PMH: Status post Kawasaki disease two weeks after developing chicken pox, attention deficit/hyperactivity disorder.


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