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This is VAERS ID 288164

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 288164
VAERS Form:
Age:13.0
Sex:Female
Location:Virgin Islands
Vaccinated:2007-08-14
Onset:2007-08-15
Submitted:2007-08-15
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0245U / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2157BA / 0 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B016BA / 5 RA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal mass, Abdominal pain, Abdominal tenderness, Anaemia, Blood alkaline phosphatase normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Labs and Diagnsotics: Abdominal US showed a large (7-8cm) solid, heterogenic mass in the pelvis and mid-abdomen. CT abdomen (+) possible ovarian or mesentaric mass. (+) ascities. CBC with WBCs of 15.5 on admission. H&H dropped to 6.4 and
CDC 'Split Type':

Write-up: mother called morning after vaccines. child c/o abdominal pain, nausea and vomiting. no fever. no diarrhea. no other symptoms.


Changed on 12/8/2009

VAERS ID: 288164 Before After
VAERS Form:
Age:13.0
Sex:Female
Location:Virgin Islands
Vaccinated:2007-08-14
Onset:2007-08-15
Submitted:2007-08-15
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0245U / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2157BA / 0 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B016BA / 5 RA / IM

Administered by: Unknown Public      Purchased by: Unknown Public
Symptoms: Abdominal mass, Abdominal pain, Abdominal tenderness, Anaemia, Blood alkaline phosphatase normal, Blood amylase decreased, Blood glucose increased, Blood lactate dehydrogenase increased, Blood product transfusion, Blood urea increased, Computerised tomogram abnormal, Full blood count, Haematocrit decreased, Haemoglobin decreased, Nausea, Proteinuria, Salpingo-oophorectomy unilateral, Vomiting, White blood cell count increased, Ultrasound abdomen abnormal, Fallopian tube disorder, Explorative laparotomy, Ovarian mass, Urine analysis abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No Yes
ER or ED Visit (V2.0)? No
Hospitalized? No Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none none. PMH: none. LMP 3 weeks ago. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnsotics: Abdominal US showed a large (7-8cm) solid, heterogenic mass in the pelvis and mid-abdomen. CT abdomen (+) possible ovarian or mesentaric mass. (+) ascities. CBC with WBCs of 15.5 on admission. H&H dropped to 6.4 and
CDC 'Split Type':

Write-up: mother called morning after vaccines. child c/o abdominal pain, nausea and vomiting. no fever. no diarrhea. no other symptoms. 09/04/2007 MR received for DOS 8/16-20/2007. Pt presented with 2 day hx of abdominal pain, nausea, vomiting. Upon PE a large protuberant mass was noted in her abdomen. (+) tenderness. Pt taken to OR for Exploratory Lap with L salpingo-oophorectomy for a hemorrhagic ovarian mass and necrosed Fallopian tube. Post-op course complicated by severe anemia. Transfused with 2 units PRBCs. Discharge DX: Left ovarian mass. Follow-up: This is follow up to form completed 8/15/07. Pnone call to mother today who state she took child to pediatrician for continued abdominal pain and vomiting. Received shot for symptoms. No relief. Went to ER and was admitted to hospital for "abdominal mass" according to mother from sonogram/CT scan.


Changed on 4/7/2010

VAERS ID: 288164 Before After
VAERS Form:
Age:13.0
Sex:Female
Location:Virgin Islands
Vaccinated:2007-08-14
Onset:2007-08-15
Submitted:2007-08-15
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0245U / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2157BA / 0 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B016BA / 5 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Abdominal mass, Abdominal pain, Abdominal tenderness, Anaemia, Blood alkaline phosphatase normal, Blood amylase decreased, Blood glucose increased, Blood lactate dehydrogenase increased, Blood product transfusion, Blood urea increased, Computerised tomogram abnormal, Full blood count, Haematocrit decreased, Haemoglobin decreased, Nausea, Proteinuria, Salpingo-oophorectomy unilateral, Vomiting, White blood cell count increased, Ultrasound abdomen abnormal, Fallopian tube disorder, Explorative laparotomy, Ovarian mass, Urine analysis abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. PMH: none. LMP 3 weeks ago. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnsotics: Abdominal US showed a large (7-8cm) solid, heterogenic mass in the pelvis and mid-abdomen. CT abdomen (+) possible ovarian or mesentaric mass. (+) ascities. CBC with WBCs of 15.5 on admission. H&H dropped to 6.4 and
CDC 'Split Type':

Write-up: mother called morning after vaccines. child c/o abdominal pain, nausea and vomiting. no fever. no diarrhea. no other symptoms. 09/04/2007 MR received for DOS 8/16-20/2007. Pt presented with 2 day hx of abdominal pain, nausea, vomiting. Upon PE a large protuberant mass was noted in her abdomen. (+) tenderness. Pt taken to OR for Exploratory Lap with L salpingo-oophorectomy for a hemorrhagic ovarian mass and necrosed Fallopian tube. Post-op course complicated by severe anemia. Transfused with 2 units PRBCs. Discharge DX: Left ovarian mass. Follow-up: This is follow up to form completed 8/15/07. Pnone call to mother today who state she took child to pediatrician for continued abdominal pain and vomiting. Received shot for symptoms. No relief. Went to ER and was admitted to hospital for "abdominal mass" according to mother from sonogram/CT scan.


Changed on 8/31/2010

VAERS ID: 288164 Before After
VAERS Form:
Age:13.0
Sex:Female
Location:Virgin Islands
Vaccinated:2007-08-14
Onset:2007-08-15
Submitted:2007-08-15
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0245U / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2157BA / 0 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B016BA / 5 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Abdominal mass, Abdominal pain, Abdominal tenderness, Anaemia, Blood alkaline phosphatase normal, Blood amylase decreased, Blood glucose increased, Blood lactate dehydrogenase increased, Blood product transfusion, Blood urea increased, Computerised tomogram abnormal, Full blood count, Haematocrit decreased, Haemoglobin decreased, Nausea, Proteinuria, Salpingo-oophorectomy unilateral, Vomiting, White blood cell count increased, Ultrasound abdomen abnormal, Fallopian tube disorder, Explorative laparotomy, Ovarian mass, Urine analysis abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. PMH: none. LMP 3 weeks ago. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnsotics: Abdominal US showed a large (7-8cm) solid, heterogenic mass in the pelvis and mid-abdomen. CT abdomen (+) possible ovarian or mesentaric mass. (+) ascities. CBC with WBCs of 15.5 on admission. H&H dropped to 6.4 and
CDC 'Split Type':

Write-up: mother called morning after vaccines. child c/o abdominal pain, nausea and vomiting. no fever. no diarrhea. no other symptoms. 09/04/2007 MR received for DOS 8/16-20/2007. Pt presented with 2 day hx of abdominal pain, nausea, vomiting. Upon PE a large protuberant mass was noted in her abdomen. (+) tenderness. Pt taken to OR for Exploratory Lap with L salpingo-oophorectomy for a hemorrhagic ovarian mass and necrosed Fallopian tube. Post-op course complicated by severe anemia. Transfused with 2 units PRBCs. Discharge DX: Left ovarian mass. Follow-up: This is follow up to form completed 8/15/07. Pnone call to mother today who state she took child to pediatrician for continued abdominal pain and vomiting. Received shot for symptoms. No relief. Went to ER and was admitted to hospital for "abdominal mass" according to mother from sonogram/CT scan.


Changed on 4/13/2011

VAERS ID: 288164 Before After
VAERS Form:
Age:13.0
Sex:Female
Location:Virgin Islands
Vaccinated:2007-08-14
Onset:2007-08-15
Submitted:2007-08-15
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0245U / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2157BA / 0 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B016BA / 5 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Abdominal mass, Abdominal pain, Abdominal tenderness, Anaemia, Blood alkaline phosphatase normal, Blood amylase decreased, Blood glucose increased, Blood lactate dehydrogenase increased, Blood product transfusion, Blood urea increased, Computerised tomogram abnormal, Full blood count, Haematocrit decreased, Haemoglobin decreased, Nausea, Proteinuria, Salpingo-oophorectomy unilateral, Vomiting, White blood cell count increased, Ultrasound abdomen abnormal, Fallopian tube disorder, Explorative laparotomy, Ovarian mass, Urine analysis abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. PMH: none. LMP 3 weeks ago. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnsotics: Abdominal US showed a large (7-8cm) solid, heterogenic mass in the pelvis and mid-abdomen. CT abdomen (+) possible ovarian or mesentaric mass. (+) ascities. CBC with WBCs of 15.5 on admission. H&H dropped to 6.4 and
CDC 'Split Type':

Write-up: mother called morning after vaccines. child c/o abdominal pain, nausea and vomiting. no fever. no diarrhea. no other symptoms. 09/04/2007 MR received for DOS 8/16-20/2007. Pt presented with 2 day hx of abdominal pain, nausea, vomiting. Upon PE a large protuberant mass was noted in her abdomen. (+) tenderness. Pt taken to OR for Exploratory Lap with L salpingo-oophorectomy for a hemorrhagic ovarian mass and necrosed Fallopian tube. Post-op course complicated by severe anemia. Transfused with 2 units PRBCs. Discharge DX: Left ovarian mass. Follow-up: This is follow up to form completed 8/15/07. Pnone call to mother today who state she took child to pediatrician for continued abdominal pain and vomiting. Received shot for symptoms. No relief. Went to ER and was admitted to hospital for "abdominal mass" according to mother from sonogram/CT scan.


Changed on 5/13/2011

VAERS ID: 288164 Before After
VAERS Form:
Age:13.0
Sex:Female
Location:Virgin Islands
Vaccinated:2007-08-14
Onset:2007-08-15
Submitted:2007-08-15
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0245U / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2157BA / 0 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B016BA / 5 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Abdominal mass, Abdominal pain, Abdominal tenderness, Anaemia, Blood alkaline phosphatase normal, Blood amylase decreased, Blood glucose increased, Blood lactate dehydrogenase increased, Blood product transfusion, Blood urea increased, Computerised tomogram abnormal, Full blood count, Haematocrit decreased, Haemoglobin decreased, Nausea, Proteinuria, Salpingo-oophorectomy unilateral, Vomiting, White blood cell count increased, Ultrasound abdomen abnormal, Fallopian tube disorder, Explorative laparotomy, Ovarian mass, Urine analysis abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. PMH: none. LMP 3 weeks ago. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnsotics: Abdominal US showed a large (7-8cm) solid, heterogenic mass in the pelvis and mid-abdomen. CT abdomen (+) possible ovarian or mesentaric mass. (+) ascities. CBC with WBCs of 15.5 on admission. H&H dropped to 6.4 and
CDC 'Split Type':

Write-up: mother called morning after vaccines. child c/o abdominal pain, nausea and vomiting. no fever. no diarrhea. no other symptoms. 09/04/2007 MR received for DOS 8/16-20/2007. Pt presented with 2 day hx of abdominal pain, nausea, vomiting. Upon PE a large protuberant mass was noted in her abdomen. (+) tenderness. Pt taken to OR for Exploratory Lap with L salpingo-oophorectomy for a hemorrhagic ovarian mass and necrosed Fallopian tube. Post-op course complicated by severe anemia. Transfused with 2 units PRBCs. Discharge DX: Left ovarian mass. Follow-up: This is follow up to form completed 8/15/07. Pnone call to mother today who state she took child to pediatrician for continued abdominal pain and vomiting. Received shot for symptoms. No relief. Went to ER and was admitted to hospital for "abdominal mass" according to mother from sonogram/CT scan.


Changed on 6/11/2011

VAERS ID: 288164 Before After
VAERS Form:
Age:13.0
Sex:Female
Location:Virgin Islands
Vaccinated:2007-08-14
Onset:2007-08-15
Submitted:2007-08-15
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0245U / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2157BA / 0 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B016BA / 5 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Abdominal mass, Abdominal pain, Abdominal tenderness, Anaemia, Blood alkaline phosphatase normal, Blood amylase decreased, Blood glucose increased, Blood lactate dehydrogenase increased, Blood product transfusion, Blood urea increased, Computerised tomogram abnormal, Full blood count, Haematocrit decreased, Haemoglobin decreased, Nausea, Proteinuria, Salpingo-oophorectomy unilateral, Vomiting, White blood cell count increased, Ultrasound abdomen abnormal, Fallopian tube disorder, Explorative laparotomy, Ovarian mass, Urine analysis abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. PMH: none. LMP 3 weeks ago. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnsotics: Abdominal US showed a large (7-8cm) solid, heterogenic mass in the pelvis and mid-abdomen. CT abdomen (+) possible ovarian or mesentaric mass. (+) ascities. CBC with WBCs of 15.5 on admission. H&H dropped to 6.4 and
CDC 'Split Type':

Write-up: mother called morning after vaccines. child c/o abdominal pain, nausea and vomiting. no fever. no diarrhea. no other symptoms. 09/04/2007 MR received for DOS 8/16-20/2007. Pt presented with 2 day hx of abdominal pain, nausea, vomiting. Upon PE a large protuberant mass was noted in her abdomen. (+) tenderness. Pt taken to OR for Exploratory Lap with L salpingo-oophorectomy for a hemorrhagic ovarian mass and necrosed Fallopian tube. Post-op course complicated by severe anemia. Transfused with 2 units PRBCs. Discharge DX: Left ovarian mass. Follow-up: This is follow up to form completed 8/15/07. Pnone call to mother today who state she took child to pediatrician for continued abdominal pain and vomiting. Received shot for symptoms. No relief. Went to ER and was admitted to hospital for "abdominal mass" according to mother from sonogram/CT scan.


Changed on 5/14/2017

VAERS ID: 288164 Before After
VAERS Form:
Age:13.0
Sex:Female
Location:Virgin Islands
Vaccinated:2007-08-14
Onset:2007-08-15
Submitted:2007-08-15
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0245U / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2157BA / 0 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B016BA / 5 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Abdominal mass, Abdominal pain, Abdominal tenderness, Anaemia, Blood alkaline phosphatase normal, Blood amylase decreased, Blood glucose increased, Blood lactate dehydrogenase increased, Blood product transfusion, Blood urea increased, Computerised tomogram abnormal, Full blood count, Haematocrit decreased, Haemoglobin decreased, Nausea, Proteinuria, Salpingo-oophorectomy unilateral, Vomiting, White blood cell count increased, Ultrasound abdomen abnormal, Fallopian tube disorder, Explorative laparotomy, Ovarian mass, Urine analysis abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. PMH: none. LMP 3 weeks ago. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnsotics: Abdominal US showed a large (7-8cm) solid, heterogenic mass in the pelvis and mid-abdomen. CT abdomen (+) possible ovarian or mesentaric mass. (+) ascities. CBC with WBCs of 15.5 on admission. H&H dropped to 6.4 and 19.1 post-op requiring 2 units PRBCs. LFT''s: AST 66, ALT 26. ALP 157. Amylase 23. LDH 2078. BUN 34. glucose 160. UA (+) for protein of 100. Unsure of exact test. Mother told me sonogram and CT scan
CDC 'Split Type':

Write-up: mother called morning after vaccines. child c/o abdominal pain, nausea and vomiting. no fever. no diarrhea. no other symptoms. 09/04/2007 MR received for DOS 8/16-20/2007. Pt presented with 2 day hx of abdominal pain, nausea, vomiting. Upon PE a large protuberant mass was noted in her abdomen. (+) tenderness. Pt taken to OR for Exploratory Lap with L salpingo-oophorectomy for a hemorrhagic ovarian mass and necrosed Fallopian tube. Post-op course complicated by severe anemia. Transfused with 2 units PRBCs. Discharge DX: Left ovarian mass. Follow-up: This is follow up to form completed 8/15/07. Pnone call to mother today who state she took child to pediatrician for continued abdominal pain and vomiting. Received shot for symptoms. No relief. Went to ER and was admitted to hospital for "abdominal mass" according to mother from sonogram/CT scan.


Changed on 9/14/2017

VAERS ID: 288164 Before After
VAERS Form:(blank) 1
Age:13.0
Sex:Female
Location:Virgin Islands
Vaccinated:2007-08-14
Onset:2007-08-15
Submitted:2007-08-15
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0245U / 0 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2157BA / 0 1 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B016BA / 5 6 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Nausea, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. PMH: none. LMP 3 weeks ago. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnsotics: Abdominal US showed a large (7-8cm) solid, heterogenic mass in the pelvis and mid-abdomen. CT abdomen (+) possible ovarian or mesentaric mass. (+) ascities. CBC with WBCs of 15.5 on admission. H&H dropped to 6.4 and 19.1 post-op requiring 2 units PRBCs. LFT''s: AST 66, ALT 26. ALP 157. Amylase 23. LDH 2078. BUN 34. glucose 160. UA (+) for protein of 100. Unsure of exact test. Mother told me sonogram and CT scan
CDC 'Split Type':

Write-up: mother called morning after vaccines. child c/o abdominal pain, nausea and vomiting. no fever. no diarrhea. no other symptoms. 09/04/2007 MR received for DOS 8/16-20/2007. Pt presented with 2 day hx of abdominal pain, nausea, vomiting. Upon PE a large protuberant mass was noted in her abdomen. (+) tenderness. Pt taken to OR for Exploratory Lap with L salpingo-oophorectomy for a hemorrhagic ovarian mass and necrosed Fallopian tube. Post-op course complicated by severe anemia. Transfused with 2 units PRBCs. Discharge DX: Left ovarian mass. Follow-up: This is follow up to form completed 8/15/07. Pnone call to mother today who state she took child to pediatrician for continued abdominal pain and vomiting. Received shot for symptoms. No relief. Went to ER and was admitted to hospital for "abdominal mass" according to mother from sonogram/CT scan.


Changed on 2/14/2018

VAERS ID: 288164 Before After
VAERS Form:1
Age:13.0
Sex:Female
Location:Virgin Islands
Vaccinated:2007-08-14
Onset:2007-08-15
Submitted:2007-08-15
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0245U / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2157BA / 1 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B016BA / 6 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Nausea, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. PMH: none. LMP 3 weeks ago. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnsotics: Abdominal US showed a large (7-8cm) solid, heterogenic mass in the pelvis and mid-abdomen. CT abdomen (+) possible ovarian or mesentaric mass. (+) ascities. CBC with WBCs of 15.5 on admission. H&H dropped to 6.4 and 19.1 post-op requiring 2 units PRBCs. LFT''s: AST 66, ALT 26. ALP 157. Amylase 23. LDH 2078. BUN 34. glucose 160. UA (+) for protein of 100. Unsure of exact test. Mother told me sonogram and CT scan
CDC 'Split Type':

Write-up: mother called morning after vaccines. child c/o abdominal pain, nausea and vomiting. no fever. no diarrhea. no other symptoms. 09/04/2007 MR received for DOS 8/16-20/2007. Pt presented with 2 day hx of abdominal pain, nausea, vomiting. Upon PE a large protuberant mass was noted in her abdomen. (+) tenderness. Pt taken to OR for Exploratory Lap with L salpingo-oophorectomy for a hemorrhagic ovarian mass and necrosed Fallopian tube. Post-op course complicated by severe anemia. Transfused with 2 units PRBCs. Discharge DX: Left ovarian mass. Follow-up: This is follow up to form completed 8/15/07. Pnone call to mother today who state she took child to pediatrician for continued abdominal pain and vomiting. Received shot for symptoms. No relief. Went to ER and was admitted to hospital for "abdominal mass" according to mother from sonogram/CT scan.


Changed on 6/14/2018

VAERS ID: 288164 Before After
VAERS Form:1
Age:13.0
Sex:Female
Location:Virgin Islands
Vaccinated:2007-08-14
Onset:2007-08-15
Submitted:2007-08-15
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0245U / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2157BA / 1 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B016BA / 6 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Nausea, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. PMH: none. LMP 3 weeks ago. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnsotics: Abdominal US showed a large (7-8cm) solid, heterogenic mass in the pelvis and mid-abdomen. CT abdomen (+) possible ovarian or mesentaric mass. (+) ascities. CBC with WBCs of 15.5 on admission. H&H dropped to 6.4 and 19.1 post-op requiring 2 units PRBCs. LFT''s: AST 66, ALT 26. ALP 157. Amylase 23. LDH 2078. BUN 34. glucose 160. UA (+) for protein of 100. Unsure of exact test. Mother told me sonogram and CT scan
CDC 'Split Type':

Write-up: mother called morning after vaccines. child c/o abdominal pain, nausea and vomiting. no fever. no diarrhea. no other symptoms. 09/04/2007 MR received for DOS 8/16-20/2007. Pt presented with 2 day hx of abdominal pain, nausea, vomiting. Upon PE a large protuberant mass was noted in her abdomen. (+) tenderness. Pt taken to OR for Exploratory Lap with L salpingo-oophorectomy for a hemorrhagic ovarian mass and necrosed Fallopian tube. Post-op course complicated by severe anemia. Transfused with 2 units PRBCs. Discharge DX: Left ovarian mass. Follow-up: This is follow up to form completed 8/15/07. Pnone call to mother today who state she took child to pediatrician for continued abdominal pain and vomiting. Received shot for symptoms. No relief. Went to ER and was admitted to hospital for "abdominal mass" according to mother from sonogram/CT scan.


Changed on 8/14/2018

VAERS ID: 288164 Before After
VAERS Form:1
Age:13.0
Sex:Female
Location:Virgin Islands
Vaccinated:2007-08-14
Onset:2007-08-15
Submitted:2007-08-15
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0245U / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2157BA / 1 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B016BA / 6 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Nausea, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. PMH: none. LMP 3 weeks ago. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnsotics: Abdominal US showed a large (7-8cm) solid, heterogenic mass in the pelvis and mid-abdomen. CT abdomen (+) possible ovarian or mesentaric mass. (+) ascities. CBC with WBCs of 15.5 on admission. H&H dropped to 6.4 and 19.1 post-op requiring 2 units PRBCs. LFT''s: AST 66, ALT 26. ALP 157. Amylase 23. LDH 2078. BUN 34. glucose 160. UA (+) for protein of 100. Unsure of exact test. Mother told me sonogram and CT scan
CDC 'Split Type':

Write-up: mother called morning after vaccines. child c/o abdominal pain, nausea and vomiting. no fever. no diarrhea. no other symptoms. 09/04/2007 MR received for DOS 8/16-20/2007. Pt presented with 2 day hx of abdominal pain, nausea, vomiting. Upon PE a large protuberant mass was noted in her abdomen. (+) tenderness. Pt taken to OR for Exploratory Lap with L salpingo-oophorectomy for a hemorrhagic ovarian mass and necrosed Fallopian tube. Post-op course complicated by severe anemia. Transfused with 2 units PRBCs. Discharge DX: Left ovarian mass. Follow-up: This is follow up to form completed 8/15/07. Pnone call to mother today who state she took child to pediatrician for continued abdominal pain and vomiting. Received shot for symptoms. No relief. Went to ER and was admitted to hospital for "abdominal mass" according to mother from sonogram/CT scan.


Changed on 9/14/2018

VAERS ID: 288164 Before After
VAERS Form:1
Age:13.0
Sex:Female
Location:Virgin Islands
Vaccinated:2007-08-14
Onset:2007-08-15
Submitted:2007-08-15
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0245U / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2157BA / 1 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B016BA / 6 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Nausea, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. PMH: none. LMP 3 weeks ago. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnsotics: Abdominal US showed a large (7-8cm) solid, heterogenic mass in the pelvis and mid-abdomen. CT abdomen (+) possible ovarian or mesentaric mass. (+) ascities. CBC with WBCs of 15.5 on admission. H&H dropped to 6.4 and 19.1 post-op requiring 2 units PRBCs. LFT''s: AST 66, ALT 26. ALP 157. Amylase 23. LDH 2078. BUN 34. glucose 160. UA (+) for protein of 100. Unsure of exact test. Mother told me sonogram and CT scan
CDC 'Split Type':

Write-up: mother called morning after vaccines. child c/o abdominal pain, nausea and vomiting. no fever. no diarrhea. no other symptoms. 09/04/2007 MR received for DOS 8/16-20/2007. Pt presented with 2 day hx of abdominal pain, nausea, vomiting. Upon PE a large protuberant mass was noted in her abdomen. (+) tenderness. Pt taken to OR for Exploratory Lap with L salpingo-oophorectomy for a hemorrhagic ovarian mass and necrosed Fallopian tube. Post-op course complicated by severe anemia. Transfused with 2 units PRBCs. Discharge DX: Left ovarian mass. Follow-up: This is follow up to form completed 8/15/07. Pnone call to mother today who state she took child to pediatrician for continued abdominal pain and vomiting. Received shot for symptoms. No relief. Went to ER and was admitted to hospital for "abdominal mass" according to mother from sonogram/CT scan.


Changed on 10/14/2018

VAERS ID: 288164 Before After
VAERS Form:1
Age:13.0
Sex:Female
Location:Virgin Islands
Vaccinated:2007-08-14
Onset:2007-08-15
Submitted:2007-08-15
Entered:2007-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0245U / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2157BA / 1 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B016BA / 6 RA / IM

Administered by: Public      Purchased by: Public
Symptoms: Abdominal pain, Nausea, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none. PMH: none. LMP 3 weeks ago. NKDA.
Allergies:
Diagnostic Lab Data: Labs and Diagnsotics: Abdominal US showed a large (7-8cm) solid, heterogenic mass in the pelvis and mid-abdomen. CT abdomen (+) possible ovarian or mesentaric mass. (+) ascities. CBC with WBCs of 15.5 on admission. H&H dropped to 6.4 and 19.1 post-op requiring 2 units PRBCs. LFT''s: AST 66, ALT 26. ALP 157. Amylase 23. LDH 2078. BUN 34. glucose 160. UA (+) for protein of 100. Unsure of exact test. Mother told me sonogram and CT scan
CDC 'Split Type':

Write-up: mother called morning after vaccines. child c/o abdominal pain, nausea and vomiting. no fever. no diarrhea. no other symptoms. 09/04/2007 MR received for DOS 8/16-20/2007. Pt presented with 2 day hx of abdominal pain, nausea, vomiting. Upon PE a large protuberant mass was noted in her abdomen. (+) tenderness. Pt taken to OR for Exploratory Lap with L salpingo-oophorectomy for a hemorrhagic ovarian mass and necrosed Fallopian tube. Post-op course complicated by severe anemia. Transfused with 2 units PRBCs. Discharge DX: Left ovarian mass. Follow-up: This is follow up to form completed 8/15/07. Pnone call to mother today who state she took child to pediatrician for continued abdominal pain and vomiting. Received shot for symptoms. No relief. Went to ER and was admitted to hospital for "abdominal mass" according to mother from sonogram/CT scan.

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