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This is VAERS ID 275111

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 275111
Age:12.0
Gender:Female
Location:North Carolina
Vaccinated:2007-03-14
Onset:0000-00-00
Submitted:2007-03-28
Entered:2007-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0181V / 0 LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Bacteraemia, Blood creatinine increased, Blood culture positive, Clostridium difficile toxin test, Bacteria urine identified

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

Write-up:Information has been received from a physician concerning a 13 year old female who, on an unspecified date, was vaccinated intramuscularly with a second dose of Gardasil. Within 24-48 hours, the patient experienced fever, achiness and diarrhea. The physic"ian reported that 1-2 days later, the patient developed blood in the stool and was admitted to the hospital. The physician reported that the patient was diagnosed with acute kidney failure and was still hospitalized. At the time of this report, the patien


Changed on 12/8/2009

VAERS ID: 275111 Before After
Age:12.0
Gender:Female
Location:North Carolina
Vaccinated:2007-03-14
Onset:0000-00-00
Submitted:2007-03-28
Entered:2007-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0181V / 0 LA / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Bacteraemia, Blood creatinine increased, Blood culture positive, Congenital cystic kidney disease, Culture urine positive, Diarrhoea, Diarrhoea haemorrhagic, Dizziness postural, Echocardiogram, Gastroenteritis rotavirus, Haematochezia, Hypotension, Nausea, Nuclear magnetic resonance imaging brain normal, Pain, Pyelonephritis, Pyrexia, Renal failure acute, Renal failure chronic, Ultrasound kidney abnormal, Urinary tract infection, Vomiting, Urosepsis, Clostridium difficile toxin test, Dialysis, Bacteria urine identified, Rotavirus test positive

Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No No
ER or Doctor Visit? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: hearing loss since age 3, wears hearing aid left ear. Pyelonephritis, renal cysts. Migraine headaches, multiple episodes of allergies, allergic rhinitis, sinusitis, pharyngitis, recurrent ear infections, gastroenteritis, tonsillitis & tonsillar hypertrophy, cellulitis & viral illness. Patient was home schooled & had hx of ADD, taking Adderall. Family HX: pat
Diagnostic Lab Data: Unknown LABS 3/18 admit: urine & blood c/s revealed E.coli. Creatinine peak at 9. Renal US revealed echogenic kidneys w/poor corticomedullary differentiation containing multiple tiny cysts; normal renal artery acceleration times w/slight
CDC 'Split Type': (blank) WAES0703USA03783

Write-up:Information has been received from a physician concerning a 13 year old female who, on an unspecified date, was vaccinated intramuscularly with a second dose of Gardasil. Within 24-48 hours, the patient experienced fever, achiness and diarrhea. The physic"ian physician reported that 1-2 days later, the patient developed blood in the stool and was admitted to the hospital. The physician reported that the patient was diagnosed with acute kidney failure and was still hospitalized. At the time of this report, the patien patient''s fever, achiness and acute kidney failure persisted. Fever, achiness and acute kidney failure were considered to be immediately life-threatening and disabling. Additional information has been requested. 5/18/07 Received medical records from hospital which reveal patient seen at hospital 3/18-3/26/07 for nausea, vomiting, bloody diarrhea & fever starting approx 3/11/07. Found to have asymptomatic E.coli UTI that traveled to kidneys. Treated w/IV antibiotics & started on dialysis & placed on kidney transplant list. Progressed well & d/c to home on oral antibiotics. FINAL DX: acute renal failure, urosepsis, polycystic kidney disease, end stage renal failure, hemodialysis. 3/27-4/2/07 - Re-Admitted to pediatric nephrology with fever, dizziness & orthostasis. Treated w/multiple IV antibiotics. Was to continue dialysis but at least 2 sessions cancelled due to hypotension. Outpatient hemodialysis was arranged closer to her home & was to continue IV antibiotics at dialysis center as well as continue on oral antibiotics. Plan was to transition to peritoneal dialysis after off antibiotics for 1 week. FINAL DX: posible partially treated urosepsis; end stage renal disease; polysystic kidney disease; rotavirus gastroenteritis; h/o acute renal failure. 4/25/07 Seen in Dialysis at outlying center. Doing well, last dose of antibiotics on 4/13 & afebrile since then. Labs were much improved & a trial of decreased dialysis was discussed. 5/4/07 - Seen in surgery clinic for evaluation of peritoneal dialy


Changed on 1/5/2010

VAERS ID: 275111 Before After
Age:12.0
Gender:Female
Location:North Carolina
Vaccinated:2007-03-14
Onset:0000-00-00 2007-03-14
Submitted:2007-03-28
Entered:2007-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0181V / 0 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Bacteraemia, Blood creatinine increased, Blood culture positive, Congenital cystic kidney disease, Culture urine positive, Diarrhoea, Diarrhoea haemorrhagic, Dizziness postural, Echocardiogram, Gastroenteritis rotavirus, Haematochezia, Hypotension, Nausea, Nuclear magnetic resonance imaging brain normal, Pain, Pyelonephritis, Pyrexia, Renal failure acute, Renal failure chronic, Ultrasound kidney abnormal, Urinary tract infection, Vomiting, Urosepsis, Clostridium difficile toxin test, Dialysis, Bacteria urine identified, Rotavirus test positive

Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: hearing loss since age 3, wears hearing aid left ear. Pyelonephritis, renal cysts. Migraine headaches, multiple episodes of allergies, allergic rhinitis, sinusitis, pharyngitis, recurrent ear infections, gastroenteritis, tonsillitis & tonsillar hypertrophy, cellulitis & viral illness. Patient was home schooled & had hx of ADD, taking Adderall. Family HX: pat
Diagnostic Lab Data: Unknown LABS 3/18 admit: urine & blood c/s revealed E.coli. Creatinine peak at 9. Renal US revealed echogenic kidneys w/poor corticomedullary differentiation containing multiple tiny cysts; normal renal artery acceleration times w/slight
CDC 'Split Type': WAES0703USA03783

Write-up:Information has been received from a physician concerning a 13 year old female who, on an unspecified date, was vaccinated intramuscularly with a second dose of Gardasil. Within 24-48 hours, the patient experienced fever, achiness and diarrhea. The physician reported that 1-2 days later, the patient developed blood in the stool and was admitted to the hospital. The physician reported that the patient was diagnosed with acute kidney failure and was still hospitalized. At the time of this report, the patient''s fever, achiness and acute kidney failure persisted. Fever, achiness and acute kidney failure were considered to be immediately life-threatening and disabling. Additional information has been requested. 5/18/07 Received medical records from hospital which reveal patient seen at hospital 3/18-3/26/07 for nausea, vomiting, bloody diarrhea & fever starting approx 3/11/07. Found to have asymptomatic E.coli UTI that traveled to kidneys. Treated w/IV antibiotics & started on dialysis & placed on kidney transplant list. Progressed well & d/c to home on oral antibiotics. FINAL DX: acute renal failure, urosepsis, polycystic kidney disease, end stage renal failure, hemodialysis. 3/27-4/2/07 - Re-Admitted to pediatric nephrology with fever, dizziness & orthostasis. Treated w/multiple IV antibiotics. Was to continue dialysis but at least 2 sessions cancelled due to hypotension. Outpatient hemodialysis was arranged closer to her home & was to continue IV antibiotics at dialysis center as well as continue on oral antibiotics. Plan was to transition to peritoneal dialysis after off antibiotics for 1 week. FINAL DX: posible partially treated urosepsis; end stage renal disease; polysystic kidney disease; rotavirus gastroenteritis; h/o acute renal failure. 4/25/07 Seen in Dialysis at outlying center. Doing well, last dose of antibiotics on 4/13 & afebrile since then. Labs were much improved & a trial of decreased dialysis was discussed. 5/4/07 - Seen in surgery clinic for evaluation of peritoneal dialy


Changed on 8/31/2010

VAERS ID: 275111 Before After
Age:12.0
Gender:Female
Location:North Carolina
Vaccinated:2007-03-14
Onset:2007-03-14
Submitted:2007-03-28
Entered:2007-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0181V / 0 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Blood creatinine increased, Diarrhoea, Dizziness postural, Haematochezia, Pain, Pyrexia, Renal failure acute, Ultrasound kidney abnormal

Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: hearing loss since age 3, wears hearing aid left ear. Pyelonephritis, renal cysts. Migraine headaches, multiple episodes of allergies, allergic rhinitis, sinusitis, pharyngitis, recurrent ear infections, gastroenteritis, tonsillitis & tonsillar hypertrophy, cellulitis & viral illness. Patient was home schooled & had hx of ADD, taking Adderall. Family HX: pat
Diagnostic Lab Data: Unknown LABS 3/18 admit: urine & blood c/s revealed E.coli. Creatinine peak at 9. Renal US revealed echogenic kidneys w/poor corticomedullary differentiation containing multiple tiny cysts; normal renal artery acceleration times w/slight
CDC 'Split Type': WAES0703USA03783

Write-up:Information has been received from a physician concerning a 13 year old female who, on an unspecified date, was vaccinated intramuscularly with a second dose of Gardasil. Within 24-48 hours, the patient experienced fever, achiness and diarrhea. The physician reported that 1-2 days later, the patient developed blood in the stool and was admitted to the hospital. The physician reported that the patient was diagnosed with acute kidney failure and was still hospitalized. At the time of this report, the patient''s fever, achiness and acute kidney failure persisted. Fever, achiness and acute kidney failure were considered to be immediately life-threatening and disabling. Additional information has been requested. 5/18/07 Received medical records from hospital which reveal patient seen at hospital 3/18-3/26/07 for nausea, vomiting, bloody diarrhea & fever starting approx 3/11/07. Found to have asymptomatic E.coli UTI that traveled to kidneys. Treated w/IV antibiotics & started on dialysis & placed on kidney transplant list. Progressed well & d/c to home on oral antibiotics. FINAL DX: acute renal failure, urosepsis, polycystic kidney disease, end stage renal failure, hemodialysis. 3/27-4/2/07 - Re-Admitted to pediatric nephrology with fever, dizziness & orthostasis. Treated w/multiple IV antibiotics. Was to continue dialysis but at least 2 sessions cancelled due to hypotension. Outpatient hemodialysis was arranged closer to her home & was to continue IV antibiotics at dialysis center as well as continue on oral antibiotics. Plan was to transition to peritoneal dialysis after off antibiotics for 1 week. FINAL DX: posible partially treated urosepsis; end stage renal disease; polysystic kidney disease; rotavirus gastroenteritis; h/o acute renal failure. 4/25/07 Seen in Dialysis at outlying center. Doing well, last dose of antibiotics on 4/13 & afebrile since then. Labs were much improved & a trial of decreased dialysis was discussed. 5/4/07 - Seen in surgery clinic for evaluation of peritoneal dialy


Changed on 1/4/2011

VAERS ID: 275111 Before After
Age:12.0
Gender:Female
Location:North Carolina
Vaccinated:2007-03-14
Onset:2007-03-14
Submitted:2007-03-28
Entered:2007-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0181V / 0 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Blood creatinine increased, Diarrhoea, Dizziness postural, Haematochezia, Pain, Pyrexia, Renal failure acute, Ultrasound kidney abnormal

Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: hearing loss since age 3, wears hearing aid left ear. Pyelonephritis, renal cysts. Migraine headaches, multiple episodes of allergies, allergic rhinitis, sinusitis, pharyngitis, recurrent ear infections, gastroenteritis, tonsillitis & tonsillar hypertrophy, cellulitis & viral illness. Patient was home schooled & had hx of ADD, taking Adderall. Family HX: pat patient''s maternal aunt w/renal failure since age 3, had 3 unsuccessful kidney transplants & died.
Diagnostic Lab Data: Unknown LABS 3/18 admit: urine & blood c/s revealed E.coli. Creatinine peak at 9. Renal US revealed echogenic kidneys w/poor corticomedullary differentiation containing multiple tiny cysts; normal renal artery acceleration times w/slight w/slightly elevated resistive indices. Repeat urine c/s neg at d/c. LABS 3/27 admit: HD catheter, urine & blood c/s neg. Rotavirus +. Creatinine 4. C. diff neg. LABS 4/25/07: serum creatinine 3.1 & creatinine clearance of 21.9mL/min 4/27/07 - TEE done which was normal & revealed no LVH. 5/7/07 MRI of brain was WNL.
CDC 'Split Type': WAES0703USA03783

Write-up:Information has been received from a physician concerning a 13 year old female who, on an unspecified date, was vaccinated intramuscularly with a second dose of Gardasil. Within 24-48 hours, the patient experienced fever, achiness and diarrhea. The physician reported that 1-2 days later, the patient developed blood in the stool and was admitted to the hospital. The physician reported that the patient was diagnosed with acute kidney failure and was still hospitalized. At the time of this report, the patient''s fever, achiness and acute kidney failure persisted. Fever, achiness and acute kidney failure were considered to be immediately life-threatening and disabling. Additional information has been requested. 5/18/07 Received medical records from hospital which reveal patient seen at hospital 3/18-3/26/07 for nausea, vomiting, bloody diarrhea & fever starting approx 3/11/07. Found to have asymptomatic E.coli UTI that traveled to kidneys. Treated w/IV antibiotics & started on dialysis & placed on kidney transplant list. Progressed well & d/c to home on oral antibiotics. FINAL DX: acute renal failure, urosepsis, polycystic kidney disease, end stage renal failure, hemodialysis. 3/27-4/2/07 - Re-Admitted to pediatric nephrology with fever, dizziness & orthostasis. Treated w/multiple IV antibiotics. Was to continue dialysis but at least 2 sessions cancelled due to hypotension. Outpatient hemodialysis was arranged closer to her home & was to continue IV antibiotics at dialysis center as well as continue on oral antibiotics. Plan was to transition to peritoneal dialysis after off antibiotics for 1 week. FINAL DX: posible partially treated urosepsis; end stage renal disease; polysystic kidney disease; rotavirus gastroenteritis; h/o acute renal failure. 4/25/07 Seen in Dialysis at outlying center. Doing well, last dose of antibiotics on 4/13 & afebrile since then. Labs were much improved & a trial of decreased dialysis was discussed. 5/4/07 - Seen in surgery clinic for evaluation of peritoneal dialy dialysis catheter for acute renal failure superimposed on chronic renal failure. HD site noted to possibly be infected & was started on oral antibiotics. Repeat stool & urine tests ordered & scheduled for PD placement. 5/7/07 MRI of brain was WNL. 6/22/07 Received medical records & vax record from reporter/provider which reveal patient received HPV on 3/14/07 & was 1st dose. VAERS database updated w/same. Medical records of 1994-2004.


Changed on 4/13/2011

VAERS ID: 275111 Before After
Age:12.0
Gender:Female
Location:North Carolina
Vaccinated:2007-03-14
Onset:2007-03-14
Submitted:2007-03-28
Entered:2007-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0181V / 0 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Bacteraemia, Blood creatinine increased, Blood culture positive, Congenital cystic kidney disease, Culture urine positive, Diarrhoea, Diarrhoea haemorrhagic, Dizziness postural, Echocardiogram, Gastroenteritis rotavirus, Haematochezia, Hypotension, Nausea, Nuclear magnetic resonance imaging brain normal, Pain, Pyelonephritis, Pyrexia, Renal failure acute, Renal failure chronic, Ultrasound kidney abnormal, Urinary tract infection, Vomiting, Urosepsis, Clostridium difficile toxin test, Dialysis, Bacteria urine identified, Rotavirus test positive

Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: hearing loss since age 3, wears hearing aid left ear. Pyelonephritis, renal cysts. Migraine headaches, multiple episodes of allergies, allergic rhinitis, sinusitis, pharyngitis, recurrent ear infections, gastroenteritis, tonsillitis & tonsillar hypertrophy, cellulitis & viral illness. Patient was home schooled & had hx of ADD, taking Adderall. Family HX: patient''s maternal aunt w/renal failure since age 3, had 3 unsuccessful kidney transplants & died.
Diagnostic Lab Data: Unknown LABS 3/18 admit: urine & blood c/s revealed E.coli. Creatinine peak at 9. Renal US revealed echogenic kidneys w/poor corticomedullary differentiation containing multiple tiny cysts; normal renal artery acceleration times w/slightly elevated resistive indices. Repeat urine c/s neg at d/c. LABS 3/27 admit: HD catheter, urine & blood c/s neg. Rotavirus +. Creatinine 4. C. diff neg. LABS 4/25/07: serum creatinine 3.1 & creatinine clearance of 21.9mL/min 4/27/07 - TEE done which was normal & revealed no LVH. 5/7/07 MRI of brain was WNL.
CDC 'Split Type': WAES0703USA03783

Write-up:Information has been received from a physician concerning a 13 year old female who, on an unspecified date, was vaccinated intramuscularly with a second dose of Gardasil. Within 24-48 hours, the patient experienced fever, achiness and diarrhea. The physician reported that 1-2 days later, the patient developed blood in the stool and was admitted to the hospital. The physician reported that the patient was diagnosed with acute kidney failure and was still hospitalized. At the time of this report, the patient''s fever, achiness and acute kidney failure persisted. Fever, achiness and acute kidney failure were considered to be immediately life-threatening and disabling. Additional information has been requested. 5/18/07 Received medical records from hospital which reveal patient seen at hospital 3/18-3/26/07 for nausea, vomiting, bloody diarrhea & fever starting approx 3/11/07. Found to have asymptomatic E.coli UTI that traveled to kidneys. Treated w/IV antibiotics & started on dialysis & placed on kidney transplant list. Progressed well & d/c to home on oral antibiotics. FINAL DX: acute renal failure, urosepsis, polycystic kidney disease, end stage renal failure, hemodialysis. 3/27-4/2/07 - Re-Admitted to pediatric nephrology with fever, dizziness & orthostasis. Treated w/multiple IV antibiotics. Was to continue dialysis but at least 2 sessions cancelled due to hypotension. Outpatient hemodialysis was arranged closer to her home & was to continue IV antibiotics at dialysis center as well as continue on oral antibiotics. Plan was to transition to peritoneal dialysis after off antibiotics for 1 week. FINAL DX: posible partially treated urosepsis; end stage renal disease; polysystic kidney disease; rotavirus gastroenteritis; h/o acute renal failure. 4/25/07 Seen in Dialysis at outlying center. Doing well, last dose of antibiotics on 4/13 & afebrile since then. Labs were much improved & a trial of decreased dialysis was discussed. 5/4/07 - Seen in surgery clinic for evaluation of peritoneal dialysis catheter for acute renal failure superimposed on chronic renal failure. HD site noted to possibly be infected & was started on oral antibiotics. Repeat stool & urine tests ordered & scheduled for PD placement. 5/7/07 MRI of brain was WNL. 6/22/07 Received medical records & vax record from reporter/provider which reveal patient received HPV on 3/14/07 & was 1st dose. VAERS database updated w/same. Medical records of 1994-2004.


Changed on 5/13/2011

VAERS ID: 275111 Before After
Age:12.0
Gender:Female
Location:North Carolina
Vaccinated:2007-03-14
Onset:2007-03-14
Submitted:2007-03-28
Entered:2007-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0181V / 0 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Bacteraemia, Blood creatinine increased, Blood culture positive, Congenital cystic kidney disease, Culture urine positive, Diarrhoea, Diarrhoea haemorrhagic, Dizziness postural, Echocardiogram, Gastroenteritis rotavirus, Haematochezia, Hypotension, Nausea, Nuclear magnetic resonance imaging brain normal, Pain, Pyelonephritis, Pyrexia, Renal failure acute, Renal failure chronic, Ultrasound kidney abnormal, Urinary tract infection, Vomiting, Urosepsis, Clostridium difficile toxin test, Dialysis, Bacteria urine identified, Rotavirus test positive

Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: hearing loss since age 3, wears hearing aid left ear. Pyelonephritis, renal cysts. Migraine headaches, multiple episodes of allergies, allergic rhinitis, sinusitis, pharyngitis, recurrent ear infections, gastroenteritis, tonsillitis & tonsillar hypertrophy, cellulitis & viral illness. Patient was home schooled & had hx of ADD, taking Adderall. Family HX: patient''s maternal aunt w/renal failure since age 3, had 3 unsuccessful kidney transplants & died.
Diagnostic Lab Data: Unknown LABS 3/18 admit: urine & blood c/s revealed E.coli. Creatinine peak at 9. Renal US revealed echogenic kidneys w/poor corticomedullary differentiation containing multiple tiny cysts; normal renal artery acceleration times w/slightly elevated resistive indices. Repeat urine c/s neg at d/c. LABS 3/27 admit: HD catheter, urine & blood c/s neg. Rotavirus +. Creatinine 4. C. diff neg. LABS 4/25/07: serum creatinine 3.1 & creatinine clearance of 21.9mL/min 4/27/07 - TEE done which was normal & revealed no LVH. 5/7/07 MRI of brain was WNL.
CDC 'Split Type': WAES0703USA03783

Write-up:Information has been received from a physician concerning a 13 year old female who, on an unspecified date, was vaccinated intramuscularly with a second dose of Gardasil. Within 24-48 hours, the patient experienced fever, achiness and diarrhea. The physician reported that 1-2 days later, the patient developed blood in the stool and was admitted to the hospital. The physician reported that the patient was diagnosed with acute kidney failure and was still hospitalized. At the time of this report, the patient''s fever, achiness and acute kidney failure persisted. Fever, achiness and acute kidney failure were considered to be immediately life-threatening and disabling. Additional information has been requested. 5/18/07 Received medical records from hospital which reveal patient seen at hospital 3/18-3/26/07 for nausea, vomiting, bloody diarrhea & fever starting approx 3/11/07. Found to have asymptomatic E.coli UTI that traveled to kidneys. Treated w/IV antibiotics & started on dialysis & placed on kidney transplant list. Progressed well & d/c to home on oral antibiotics. FINAL DX: acute renal failure, urosepsis, polycystic kidney disease, end stage renal failure, hemodialysis. 3/27-4/2/07 - Re-Admitted to pediatric nephrology with fever, dizziness & orthostasis. Treated w/multiple IV antibiotics. Was to continue dialysis but at least 2 sessions cancelled due to hypotension. Outpatient hemodialysis was arranged closer to her home & was to continue IV antibiotics at dialysis center as well as continue on oral antibiotics. Plan was to transition to peritoneal dialysis after off antibiotics for 1 week. FINAL DX: posible partially treated urosepsis; end stage renal disease; polysystic kidney disease; rotavirus gastroenteritis; h/o acute renal failure. 4/25/07 Seen in Dialysis at outlying center. Doing well, last dose of antibiotics on 4/13 & afebrile since then. Labs were much improved & a trial of decreased dialysis was discussed. 5/4/07 - Seen in surgery clinic for evaluation of peritoneal dialysis catheter for acute renal failure superimposed on chronic renal failure. HD site noted to possibly be infected & was started on oral antibiotics. Repeat stool & urine tests ordered & scheduled for PD placement. 5/7/07 MRI of brain was WNL. 6/22/07 Received medical records & vax record from reporter/provider which reveal patient received HPV on 3/14/07 & was 1st dose. VAERS database updated w/same. Medical records of 1994-2004.


Changed on 6/11/2011

VAERS ID: 275111 Before After
Age:12.0
Gender:Female
Location:North Carolina
Vaccinated:2007-03-14
Onset:2007-03-14
Submitted:2007-03-28
Entered:2007-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0181V / 0 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Bacteraemia, Blood creatinine increased, Blood culture positive, Congenital cystic kidney disease, Culture urine positive, Diarrhoea, Diarrhoea haemorrhagic, Dizziness postural, Echocardiogram, Gastroenteritis rotavirus, Haematochezia, Hypotension, Nausea, Nuclear magnetic resonance imaging brain normal, Pain, Pyelonephritis, Pyrexia, Renal failure acute, Renal failure chronic, Ultrasound kidney abnormal, Urinary tract infection, Vomiting, Urosepsis, Clostridium difficile toxin test, Dialysis, Bacteria urine identified, Rotavirus test positive

Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: hearing loss since age 3, wears hearing aid left ear. Pyelonephritis, renal cysts. Migraine headaches, multiple episodes of allergies, allergic rhinitis, sinusitis, pharyngitis, recurrent ear infections, gastroenteritis, tonsillitis & tonsillar hypertrophy, cellulitis & viral illness. Patient was home schooled & had hx of ADD, taking Adderall. Family HX: patient''s maternal aunt w/renal failure since age 3, had 3 unsuccessful kidney transplants & died.
Diagnostic Lab Data: Unknown LABS 3/18 admit: urine & blood c/s revealed E.coli. Creatinine peak at 9. Renal US revealed echogenic kidneys w/poor corticomedullary differentiation containing multiple tiny cysts; normal renal artery acceleration times w/slightly elevated resistive indices. Repeat urine c/s neg at d/c. LABS 3/27 admit: HD catheter, urine & blood c/s neg. Rotavirus +. Creatinine 4. C. diff neg. LABS 4/25/07: serum creatinine 3.1 & creatinine clearance of 21.9mL/min 4/27/07 - TEE done which was normal & revealed no LVH. 5/7/07 MRI of brain was WNL.
CDC 'Split Type': WAES0703USA03783

Write-up:Information has been received from a physician concerning a 13 year old female who, on an unspecified date, was vaccinated intramuscularly with a second dose of Gardasil. Within 24-48 hours, the patient experienced fever, achiness and diarrhea. The physician reported that 1-2 days later, the patient developed blood in the stool and was admitted to the hospital. The physician reported that the patient was diagnosed with acute kidney failure and was still hospitalized. At the time of this report, the patient''s fever, achiness and acute kidney failure persisted. Fever, achiness and acute kidney failure were considered to be immediately life-threatening and disabling. Additional information has been requested. 5/18/07 Received medical records from hospital which reveal patient seen at hospital 3/18-3/26/07 for nausea, vomiting, bloody diarrhea & fever starting approx 3/11/07. Found to have asymptomatic E.coli UTI that traveled to kidneys. Treated w/IV antibiotics & started on dialysis & placed on kidney transplant list. Progressed well & d/c to home on oral antibiotics. FINAL DX: acute renal failure, urosepsis, polycystic kidney disease, end stage renal failure, hemodialysis. 3/27-4/2/07 - Re-Admitted to pediatric nephrology with fever, dizziness & orthostasis. Treated w/multiple IV antibiotics. Was to continue dialysis but at least 2 sessions cancelled due to hypotension. Outpatient hemodialysis was arranged closer to her home & was to continue IV antibiotics at dialysis center as well as continue on oral antibiotics. Plan was to transition to peritoneal dialysis after off antibiotics for 1 week. FINAL DX: posible partially treated urosepsis; end stage renal disease; polysystic kidney disease; rotavirus gastroenteritis; h/o acute renal failure. 4/25/07 Seen in Dialysis at outlying center. Doing well, last dose of antibiotics on 4/13 & afebrile since then. Labs were much improved & a trial of decreased dialysis was discussed. 5/4/07 - Seen in surgery clinic for evaluation of peritoneal dialysis catheter for acute renal failure superimposed on chronic renal failure. HD site noted to possibly be infected & was started on oral antibiotics. Repeat stool & urine tests ordered & scheduled for PD placement. 5/7/07 MRI of brain was WNL. 6/22/07 Received medical records & vax record from reporter/provider which reveal patient received HPV on 3/14/07 & was 1st dose. VAERS database updated w/same. Medical records of 1994-2004.


Changed on 6/14/2014

VAERS ID: 275111 Before After
Age:12.0
Gender:Female
Location:North Carolina
Vaccinated:2007-03-14
Onset:2007-03-14
Submitted:2007-03-28
Entered:2007-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0181V / 0 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Bacteraemia, Blood creatinine increased, Blood culture positive, Congenital cystic kidney disease, Culture urine positive, Diarrhoea, Diarrhoea haemorrhagic, Dizziness postural, Echocardiogram, Gastroenteritis rotavirus, Haematochezia, Hypotension, Nausea, Nuclear magnetic resonance imaging brain normal, Pain, Pyelonephritis, Pyrexia, Renal failure acute, Renal failure chronic, Ultrasound kidney abnormal, Urinary tract infection, Vomiting, Urosepsis, Clostridium difficile toxin test, Dialysis, Bacteria urine identified, Rotavirus test positive

Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: hearing loss since age 3, wears hearing aid left ear. Pyelonephritis, renal cysts. Migraine headaches, multiple episodes of allergies, allergic rhinitis, sinusitis, pharyngitis, recurrent ear infections, gastroenteritis, tonsillitis & tonsillar hypertrophy, cellulitis & viral illness. Patient was home schooled & had hx of ADD, taking Adderall. Family HX: patient''s maternal aunt w/renal failure since age 3, had 3 unsuccessful kidney transplants & died.
Diagnostic Lab Data: Unknown LABS 3/18 admit: urine & blood c/s revealed E.coli. Creatinine peak at 9. Renal US revealed echogenic kidneys w/poor corticomedullary differentiation containing multiple tiny cysts; normal renal artery acceleration times w/slightly elevated resistive indices. Repeat urine c/s neg at d/c. LABS 3/27 admit: HD catheter, urine & blood c/s neg. Rotavirus +. Creatinine 4. C. diff neg. LABS 4/25/07: serum creatinine 3.1 & creatinine clearance of 21.9mL/min 4/27/07 - TEE done which was normal & revealed no LVH. 5/7/07 MRI of brain was WNL.
CDC 'Split Type': WAES0703USA03783

Write-up:Information has been received from a physician concerning a 13 year old female who, on an unspecified date, was vaccinated intramuscularly with a second dose of Gardasil. Within 24-48 hours, the patient experienced fever, achiness and diarrhea. The physician reported that 1-2 days later, the patient developed blood in the stool and was admitted to the hospital. The physician reported that the patient was diagnosed with acute kidney failure and was still hospitalized. At the time of this report, the patient''s fever, achiness and acute kidney failure persisted. Fever, achiness and acute kidney failure were considered to be immediately life-threatening and disabling. Additional information has been requested. 5/18/07 Received medical records from hospital which reveal patient seen at hospital 3/18-3/26/07 for nausea, vomiting, bloody diarrhea & fever starting approx 3/11/07. Found to have asymptomatic E.coli UTI that traveled to kidneys. Treated w/IV antibiotics & started on dialysis & placed on kidney transplant list. Progressed well & d/c to home on oral antibiotics. FINAL DX: acute renal failure, urosepsis, polycystic kidney disease, end stage renal failure, hemodialysis. 3/27-4/2/07 - Re-Admitted to pediatric nephrology with fever, dizziness & orthostasis. Treated w/multiple IV antibiotics. Was to continue dialysis but at least 2 sessions cancelled due to hypotension. Outpatient hemodialysis was arranged closer to her home & was to continue IV antibiotics at dialysis center as well as continue on oral antibiotics. Plan was to transition to peritoneal dialysis after off antibiotics for 1 week. FINAL DX: posible partially treated urosepsis; end stage renal disease; polysystic kidney disease; rotavirus gastroenteritis; h/o acute renal failure. 4/25/07 Seen in Dialysis at outlying center. Doing well, last dose of antibiotics on 4/13 & afebrile since then. Labs were much improved & a trial of decreased dialysis was discussed. 5/4/07 - Seen in surgery clinic for evaluation of peritoneal dialysis catheter for acute renal failure superimposed on chronic renal failure. HD site noted to possibly be infected & was started on oral antibiotics. Repeat stool & urine tests ordered & scheduled for PD placement. 5/7/07 MRI of brain was WNL. 6/22/07 Received medical records & vax record from reporter/provider which reveal patient received HPV on 3/14/07 & was 1st dose. VAERS database updated w/same. Medical records of 1994-2004.


Changed on 5/14/2017

VAERS ID: 275111 Before After
Age:12.0
Gender:Female
Location:North Carolina
Vaccinated:2007-03-14
Onset:2007-03-14
Submitted:2007-03-28
Entered:2007-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0181V / 0 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Bacteraemia, Blood creatinine increased, Blood culture positive, Congenital cystic kidney disease, Culture urine positive, Diarrhoea, Diarrhoea haemorrhagic, Dizziness postural, Echocardiogram, Gastroenteritis rotavirus, Haematochezia, Hypotension, Nausea, Nuclear magnetic resonance imaging brain normal, Pain, Pyelonephritis, Pyrexia, Renal failure acute, Renal failure chronic, Ultrasound kidney abnormal, Urinary tract infection, Vomiting, Urosepsis, Clostridium difficile toxin test, Dialysis, Bacteria urine identified, Rotavirus test positive

Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: hearing loss since age 3, wears hearing aid left ear. Pyelonephritis, renal cysts. Migraine headaches, multiple episodes of allergies, allergic rhinitis, sinusitis, pharyngitis, recurrent ear infections, gastroenteritis, tonsillitis & tonsillar hypertrophy, cellulitis & viral illness. Patient was home schooled & had hx of ADD, taking Adderall. Family HX: patient''s maternal aunt w/renal failure since age 3, had 3 unsuccessful kidney transplants & died.
Diagnostic Lab Data: Unknown LABS 3/18 admit: urine & blood c/s revealed E.coli. Creatinine peak at 9. Renal US revealed echogenic kidneys w/poor corticomedullary differentiation containing multiple tiny cysts; normal renal artery acceleration times w/slightly elevated resistive indices. Repeat urine c/s neg at d/c. LABS 3/27 admit: HD catheter, urine & blood c/s neg. Rotavirus +. Creatinine 4. C. diff neg. LABS 4/25/07: serum creatinine 3.1 & creatinine clearance of 21.9mL/min 4/27/07 - TEE done which was normal & revealed no LVH. 5/7/07 MRI of brain was WNL.
CDC 'Split Type': WAES0703USA03783

Write-up:Information has been received from a physician concerning a 13 year old female who, on an unspecified date, was vaccinated intramuscularly with a second dose of Gardasil. Within 24-48 hours, the patient experienced fever, achiness and diarrhea. The physician reported that 1-2 days later, the patient developed blood in the stool and was admitted to the hospital. The physician reported that the patient was diagnosed with acute kidney failure and was still hospitalized. At the time of this report, the patient''s fever, achiness and acute kidney failure persisted. Fever, achiness and acute kidney failure were considered to be immediately life-threatening and disabling. Additional information has been requested. 5/18/07 Received medical records from hospital which reveal patient seen at hospital 3/18-3/26/07 for nausea, vomiting, bloody diarrhea & fever starting approx 3/11/07. Found to have asymptomatic E.coli UTI that traveled to kidneys. Treated w/IV antibiotics & started on dialysis & placed on kidney transplant list. Progressed well & d/c to home on oral antibiotics. FINAL DX: acute renal failure, urosepsis, polycystic kidney disease, end stage renal failure, hemodialysis. 3/27-4/2/07 - Re-Admitted to pediatric nephrology with fever, dizziness & orthostasis. Treated w/multiple IV antibiotics. Was to continue dialysis but at least 2 sessions cancelled due to hypotension. Outpatient hemodialysis was arranged closer to her home & was to continue IV antibiotics at dialysis center as well as continue on oral antibiotics. Plan was to transition to peritoneal dialysis after off antibiotics for 1 week. FINAL DX: posible partially treated urosepsis; end stage renal disease; polysystic kidney disease; rotavirus gastroenteritis; h/o acute renal failure. 4/25/07 Seen in Dialysis at outlying center. Doing well, last dose of antibiotics on 4/13 & afebrile since then. Labs were much improved & a trial of decreased dialysis was discussed. 5/4/07 - Seen in surgery clinic for evaluation of peritoneal dialysis catheter for acute renal failure superimposed on chronic renal failure. HD site noted to possibly be infected & was started on oral antibiotics. Repeat stool & urine tests ordered & scheduled for PD placement. 5/7/07 MRI of brain was WNL. 6/22/07 Received medical records & vax record from reporter/provider which reveal patient received HPV on 3/14/07 & was 1st dose. VAERS database updated w/same. Medical records of 1994-2004.


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