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This is VAERS ID 289694

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 289694
VAERS Form:
Age:15.0
Sex:Female
Location:Texas
Vaccinated:2007-08-22
Onset:2007-08-22
Submitted:2007-08-24
Entered:2007-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0927U / 1 LA / IM

Administered by: Public      Purchased by: Unknown
Symptoms: Asthenia, Blood creatine phosphokinase normal, C-reactive protein normal, Confusional state

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Per mother lab tests were done. Labs and Diagnostics: MRI brain unremarkable with the exception of a couple non-specific punctate foci of increased flair signal in the subcortical white matter of the frontal lobes. CMV and EBV IgG (+),
CDC 'Split Type':

Write-up: Per mother 2 hours after injection behavior changes, unaware of surrounding. Pt went to ER. In 4 days. pt returned to ER Blood test and MRI were done Per mom everything was normal. Pt discharged 8/28/07. 09/25/2007 MR received for DOS 8/23/2007 for D/C"DX of Disorientation, weakness resolved and additional records for 8/24-28/07. Pt presented to ER x 2 with mental status changes, confusion, and dizziness. Was D/C after all labs were normal. Increasing fatigue and weakness in the BLEs resulted in retur


Changed on 12/8/2009

VAERS ID: 289694 Before After
VAERS Form:
Age:15.0
Sex:Female
Location:Texas
Vaccinated:2007-08-22
Onset:2007-08-22
Submitted:2007-08-24
Entered:2007-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0927U / 1 LA / IM

Administered by: Public      Purchased by: Unknown Private
Symptoms: Asthenia, Blood creatine phosphokinase normal, C-reactive protein normal, Confusional state, Disorientation, Dizziness, Fatigue, Nuclear magnetic resonance imaging brain, Mental status changes, Red blood cell sedimentation rate normal, Cytomegalovirus antibody positive, Drug screen negative, Epstein-Barr virus antibody positive, Epstein-Barr virus antibody negative, Laboratory test, Cytomegalovirus antibody negative

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Per mother lab tests were done. Labs and Diagnostics: MRI brain unremarkable with the exception of a couple non-specific punctate foci of increased flair signal in the subcortical white matter of the frontal lobes. CMV and EBV IgG (+),
CDC 'Split Type':

Write-up: Per mother 2 hours after injection behavior changes, unaware of surrounding. Pt went to ER. In 4 days. pt returned to ER Blood test and MRI were done Per mom everything was normal. Pt discharged 8/28/07. 09/25/2007 MR received for DOS 8/23/2007 for D/C"DX D/C DX of Disorientation, weakness resolved and additional records for 8/24-28/07. Pt presented to ER x 2 with mental status changes, confusion, and dizziness. Was D/C after all labs were normal. Increasing fatigue and weakness in the BLEs resulted in retur return to ER. Confusion was improved at this time. PE shows 4/5 LE stength. Otherwise WNL. Neuro attending reports hx and exam not suggestive of severe neuro complication. Disorientation c/w orthostasis, improved with IVF. Discharged 8/27/07 in improved condition with normal exam.


Changed on 5/14/2017

VAERS ID: 289694 Before After
VAERS Form:
Age:15.0
Sex:Female
Location:Texas
Vaccinated:2007-08-22
Onset:2007-08-22
Submitted:2007-08-24
Entered:2007-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0927U / 1 LA / IM

Administered by: Public      Purchased by: Private
Symptoms: Asthenia, Blood creatine phosphokinase normal, C-reactive protein normal, Confusional state, Disorientation, Dizziness, Fatigue, Nuclear magnetic resonance imaging brain, Mental status changes, Red blood cell sedimentation rate normal, Cytomegalovirus antibody positive, Drug screen negative, Epstein-Barr virus antibody positive, Epstein-Barr virus antibody negative, Laboratory test, Cytomegalovirus antibody negative

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Per mother lab tests were done. Labs and Diagnostics: MRI brain unremarkable with the exception of a couple non-specific punctate foci of increased flair signal in the subcortical white matter of the frontal lobes. CMV and EBV IgG (+), IgM (-). Drug screen (-). Sed rate 10. CK 36. CRP <0.3.
CDC 'Split Type':

Write-up: Per mother 2 hours after injection behavior changes, unaware of surrounding. Pt went to ER. In 4 days. pt returned to ER Blood test and MRI were done Per mom everything was normal. Pt discharged 8/28/07. 09/25/2007 MR received for DOS 8/23/2007 for D/C DX of Disorientation, weakness resolved and additional records for 8/24-28/07. Pt presented to ER x 2 with mental status changes, confusion, and dizziness. Was D/C after all labs were normal. Increasing fatigue and weakness in the BLEs resulted in return to ER. Confusion was improved at this time. PE shows 4/5 LE stength. Otherwise WNL. Neuro attending reports hx and exam not suggestive of severe neuro complication. Disorientation c/w orthostasis, improved with IVF. Discharged 8/27/07 in improved condition with normal exam.


Changed on 9/14/2017

VAERS ID: 289694 Before After
VAERS Form:(blank) 1
Age:15.0
Sex:Female
Location:Texas
Vaccinated:2007-08-22
Onset:2007-08-22
Submitted:2007-08-24
Entered:2007-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0927U / 1 2 LA / IM

Administered by: Public      Purchased by: Private
Symptoms: Confusional state, Laboratory test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Per mother lab tests were done. Labs and Diagnostics: MRI brain unremarkable with the exception of a couple non-specific punctate foci of increased flair signal in the subcortical white matter of the frontal lobes. CMV and EBV IgG (+), IgM (-). Drug screen (-). Sed rate 10. CK 36. CRP <0.3.
CDC 'Split Type':

Write-up: Per mother 2 hours after injection behavior changes, unaware of surrounding. Pt went to ER. In 4 days. pt returned to ER Blood test and MRI were done Per mom everything was normal. Pt discharged 8/28/07. 09/25/2007 MR received for DOS 8/23/2007 for D/C DX of Disorientation, weakness resolved and additional records for 8/24-28/07. Pt presented to ER x 2 with mental status changes, confusion, and dizziness. Was D/C after all labs were normal. Increasing fatigue and weakness in the BLEs resulted in return to ER. Confusion was improved at this time. PE shows 4/5 LE stength. Otherwise WNL. Neuro attending reports hx and exam not suggestive of severe neuro complication. Disorientation c/w orthostasis, improved with IVF. Discharged 8/27/07 in improved condition with normal exam.


Changed on 2/14/2018

VAERS ID: 289694 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Texas
Vaccinated:2007-08-22
Onset:2007-08-22
Submitted:2007-08-24
Entered:2007-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0927U / 2 LA / IM

Administered by: Public      Purchased by: Private
Symptoms: Confusional state, Laboratory test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Per mother lab tests were done. Labs and Diagnostics: MRI brain unremarkable with the exception of a couple non-specific punctate foci of increased flair signal in the subcortical white matter of the frontal lobes. CMV and EBV IgG (+), IgM (-). Drug screen (-). Sed rate 10. CK 36. CRP <0.3.
CDC 'Split Type':

Write-up: Per mother 2 hours after injection behavior changes, unaware of surrounding. Pt went to ER. In 4 days. pt returned to ER Blood test and MRI were done Per mom everything was normal. Pt discharged 8/28/07. 09/25/2007 MR received for DOS 8/23/2007 for D/C DX of Disorientation, weakness resolved and additional records for 8/24-28/07. Pt presented to ER x 2 with mental status changes, confusion, and dizziness. Was D/C after all labs were normal. Increasing fatigue and weakness in the BLEs resulted in return to ER. Confusion was improved at this time. PE shows 4/5 LE stength. Otherwise WNL. Neuro attending reports hx and exam not suggestive of severe neuro complication. Disorientation c/w orthostasis, improved with IVF. Discharged 8/27/07 in improved condition with normal exam.


Changed on 6/14/2018

VAERS ID: 289694 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Texas
Vaccinated:2007-08-22
Onset:2007-08-22
Submitted:2007-08-24
Entered:2007-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0927U / 2 LA / IM

Administered by: Public      Purchased by: Private
Symptoms: Confusional state, Laboratory test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Per mother lab tests were done. Labs and Diagnostics: MRI brain unremarkable with the exception of a couple non-specific punctate foci of increased flair signal in the subcortical white matter of the frontal lobes. CMV and EBV IgG (+), IgM (-). Drug screen (-). Sed rate 10. CK 36. CRP <0.3.
CDC 'Split Type':

Write-up: Per mother 2 hours after injection behavior changes, unaware of surrounding. Pt went to ER. In 4 days. pt returned to ER Blood test and MRI were done Per mom everything was normal. Pt discharged 8/28/07. 09/25/2007 MR received for DOS 8/23/2007 for D/C DX of Disorientation, weakness resolved and additional records for 8/24-28/07. Pt presented to ER x 2 with mental status changes, confusion, and dizziness. Was D/C after all labs were normal. Increasing fatigue and weakness in the BLEs resulted in return to ER. Confusion was improved at this time. PE shows 4/5 LE stength. Otherwise WNL. Neuro attending reports hx and exam not suggestive of severe neuro complication. Disorientation c/w orthostasis, improved with IVF. Discharged 8/27/07 in improved condition with normal exam.


Changed on 8/14/2018

VAERS ID: 289694 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Texas
Vaccinated:2007-08-22
Onset:2007-08-22
Submitted:2007-08-24
Entered:2007-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0927U / 2 LA / IM

Administered by: Public      Purchased by: Private
Symptoms: Confusional state, Laboratory test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Per mother lab tests were done. Labs and Diagnostics: MRI brain unremarkable with the exception of a couple non-specific punctate foci of increased flair signal in the subcortical white matter of the frontal lobes. CMV and EBV IgG (+), IgM (-). Drug screen (-). Sed rate 10. CK 36. CRP <0.3.
CDC 'Split Type':

Write-up: Per mother 2 hours after injection behavior changes, unaware of surrounding. Pt went to ER. In 4 days. pt returned to ER Blood test and MRI were done Per mom everything was normal. Pt discharged 8/28/07. 09/25/2007 MR received for DOS 8/23/2007 for D/C DX of Disorientation, weakness resolved and additional records for 8/24-28/07. Pt presented to ER x 2 with mental status changes, confusion, and dizziness. Was D/C after all labs were normal. Increasing fatigue and weakness in the BLEs resulted in return to ER. Confusion was improved at this time. PE shows 4/5 LE stength. Otherwise WNL. Neuro attending reports hx and exam not suggestive of severe neuro complication. Disorientation c/w orthostasis, improved with IVF. Discharged 8/27/07 in improved condition with normal exam.


Changed on 9/14/2018

VAERS ID: 289694 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Texas
Vaccinated:2007-08-22
Onset:2007-08-22
Submitted:2007-08-24
Entered:2007-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0927U / 2 LA / IM

Administered by: Public      Purchased by: Private
Symptoms: Confusional state, Laboratory test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Per mother lab tests were done. Labs and Diagnostics: MRI brain unremarkable with the exception of a couple non-specific punctate foci of increased flair signal in the subcortical white matter of the frontal lobes. CMV and EBV IgG (+), IgM (-). Drug screen (-). Sed rate 10. CK 36. CRP <0.3.
CDC 'Split Type':

Write-up: Per mother 2 hours after injection behavior changes, unaware of surrounding. Pt went to ER. In 4 days. pt returned to ER Blood test and MRI were done Per mom everything was normal. Pt discharged 8/28/07. 09/25/2007 MR received for DOS 8/23/2007 for D/C DX of Disorientation, weakness resolved and additional records for 8/24-28/07. Pt presented to ER x 2 with mental status changes, confusion, and dizziness. Was D/C after all labs were normal. Increasing fatigue and weakness in the BLEs resulted in return to ER. Confusion was improved at this time. PE shows 4/5 LE stength. Otherwise WNL. Neuro attending reports hx and exam not suggestive of severe neuro complication. Disorientation c/w orthostasis, improved with IVF. Discharged 8/27/07 in improved condition with normal exam.


Changed on 10/14/2018

VAERS ID: 289694 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Texas
Vaccinated:2007-08-22
Onset:2007-08-22
Submitted:2007-08-24
Entered:2007-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0927U / 2 LA / IM

Administered by: Public      Purchased by: Private
Symptoms: Confusional state, Laboratory test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None. PMH: none. NKDA.
Allergies:
Diagnostic Lab Data: Per mother lab tests were done. Labs and Diagnostics: MRI brain unremarkable with the exception of a couple non-specific punctate foci of increased flair signal in the subcortical white matter of the frontal lobes. CMV and EBV IgG (+), IgM (-). Drug screen (-). Sed rate 10. CK 36. CRP <0.3.
CDC 'Split Type':

Write-up: Per mother 2 hours after injection behavior changes, unaware of surrounding. Pt went to ER. In 4 days. pt returned to ER Blood test and MRI were done Per mom everything was normal. Pt discharged 8/28/07. 09/25/2007 MR received for DOS 8/23/2007 for D/C DX of Disorientation, weakness resolved and additional records for 8/24-28/07. Pt presented to ER x 2 with mental status changes, confusion, and dizziness. Was D/C after all labs were normal. Increasing fatigue and weakness in the BLEs resulted in return to ER. Confusion was improved at this time. PE shows 4/5 LE stength. Otherwise WNL. Neuro attending reports hx and exam not suggestive of severe neuro complication. Disorientation c/w orthostasis, improved with IVF. Discharged 8/27/07 in improved condition with normal exam.

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