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This is VAERS ID 291301

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 291301
VAERS Form:
Age:15.0
Sex:Female
Location:Massachusetts
Vaccinated:2007-09-11
Onset:2007-09-11
Submitted:2007-09-13
Entered:2007-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1062U / 2 RA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Chest X-ray, Chest X-ray normal, Computerised tomogram abnormal, Dehydration

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Rx prescribed by pts. GYN to moderate periods.
Current Illness: None
Preexisting Conditions: Idiopathic lower extremity edema
Allergies:
Diagnostic Lab Data: Abd/pelvic CT - small amt fluid in cul-de-sac - o/w negative; - KUB; - CXR; CBC; WBC 21,600 with 87 polys/4 bands
CDC 'Split Type':

Write-up: Pt developed abd. pain, vomiting within 1 hr of vaccine administration. Also was lightheaded (dizzy) - evaluated in ER and admitted for IV hydration (dehydrated)


Changed on 12/8/2009

VAERS ID: 291301 Before After
VAERS Form:
Age:15.0
Sex:Female
Location:Massachusetts
Vaccinated:2007-09-11
Onset:2007-09-11
Submitted:2007-09-13
Entered:2007-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1062U / 2 RA / IM

Administered by: Private      Purchased by: Unknown Public
Symptoms: Abdominal pain, Chest X-ray, Chest X-ray normal, Computerised tomogram abnormal, Dehydration, Dizziness, Full blood count, Urinary system X-ray, Vomiting, White blood cell count increased

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Rx prescribed by pts. GYN to moderate periods.
Current Illness: None
Preexisting Conditions: Idiopathic lower extremity edema
Allergies:
Diagnostic Lab Data: Abd/pelvic CT - small amt fluid in cul-de-sac - o/w negative; - KUB; - CXR; CBC; WBC 21,600 with 87 polys/4 bands 10/4/07-diagnostic reports received for DOS 9/11-9/12/07-WBC 21.6, Poly 87, Glucose 170, Bilirubin total 1.45, urine ketones
CDC 'Split Type':

Write-up: Pt developed abd. pain, vomiting within 1 hr of vaccine administration. Also was lightheaded (dizzy) - evaluated in ER and admitted for IV hydration (dehydrated) 11/6/07-records received for DOS 9/11-9/12/07-DC DX: Vomiting resolved. Dehydration resolved. Admitted with complaint of vomiting and abdominal pain which began yesterday suddenly.


Changed on 4/14/2017

VAERS ID: 291301 Before After
VAERS Form:
Age:15.0
Sex:Female
Location:Massachusetts
Vaccinated:2007-09-11
Onset:2007-09-11
Submitted:2007-09-13
Entered:2007-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1062U / 2 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Chest X-ray, Chest X-ray normal, Computerised tomogram abnormal, Dehydration, Dizziness, Full blood count, Urinary system X-ray, Vomiting, White blood cell count increased

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Rx prescribed by pts. GYN to moderate periods.
Current Illness: None
Preexisting Conditions: Idiopathic lower extremity edema
Allergies:
Diagnostic Lab Data: Abd/pelvic CT - small amt fluid in cul-de-sac - o/w negative; - KUB; - CXR; CBC; WBC 21,600 with 87 polys/4 bands 10/4/07-diagnostic reports received for DOS 9/11-9/12/07-WBC 21.6, Poly 87, Glucose 170, Bilirubin total 1.45, urine ketones 40, mono positive, Blood culture no growth. EBV CAPSID IgM positive.CT abdomen and pelvis trace amount fluid in cul-de-sac, left ovary slightly larger than right. Consistent with mittelschmerz. Leukocytosis 21,600. Amylase 50 and lipase 15. Mono test positive.
CDC 'Split Type':

Write-up: Pt developed abd. pain, vomiting within 1 hr of vaccine administration. Also was lightheaded (dizzy) - evaluated in ER and admitted for IV hydration (dehydrated) 11/6/07-records received for DOS 9/11-9/12/07-DC DX: Vomiting resolved. Dehydration resolved. Admitted with complaint of vomiting and abdominal pain which began yesterday suddenly.


Changed on 9/14/2017

VAERS ID: 291301 Before After
VAERS Form:(blank) 1
Age:15.0
Sex:Female
Location:Massachusetts
Vaccinated:2007-09-11
Onset:2007-09-11
Submitted:2007-09-13
Entered:2007-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1062U / 2 3 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Chest X-ray, Chest X-ray normal, Computerised tomogram abnormal, Dehydration, Dizziness, Full blood count, Urinary system X-ray, Vomiting, White blood cell count increased

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Rx prescribed by pts. GYN to moderate periods.
Current Illness: None
Preexisting Conditions: Idiopathic lower extremity edema
Allergies:
Diagnostic Lab Data: Abd/pelvic CT - small amt fluid in cul-de-sac - o/w negative; - KUB; - CXR; CBC; WBC 21,600 with 87 polys/4 bands 10/4/07-diagnostic reports received for DOS 9/11-9/12/07-WBC 21.6, Poly 87, Glucose 170, Bilirubin total 1.45, urine ketones 40, mono positive, Blood culture no growth. EBV CAPSID IgM positive.CT abdomen and pelvis trace amount fluid in cul-de-sac, left ovary slightly larger than right. Consistent with mittelschmerz. Leukocytosis 21,600. Amylase 50 and lipase 15. Mono test positive.
CDC 'Split Type':

Write-up: Pt developed abd. pain, vomiting within 1 hr of vaccine administration. Also was lightheaded (dizzy) - evaluated in ER and admitted for IV hydration (dehydrated) 11/6/07-records received for DOS 9/11-9/12/07-DC DX: Vomiting resolved. Dehydration resolved. Admitted with complaint of vomiting and abdominal pain which began yesterday suddenly.


Changed on 2/14/2018

VAERS ID: 291301 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Massachusetts
Vaccinated:2007-09-11
Onset:2007-09-11
Submitted:2007-09-13
Entered:2007-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1062U / 3 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Chest X-ray, Chest X-ray normal, Computerised tomogram abnormal, Dehydration, Dizziness, Full blood count, Urinary system X-ray, Vomiting, White blood cell count increased

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Rx prescribed by pts. GYN to moderate periods.
Current Illness: None
Preexisting Conditions: Idiopathic lower extremity edema
Allergies:
Diagnostic Lab Data: Abd/pelvic CT - small amt fluid in cul-de-sac - o/w negative; - KUB; - CXR; CBC; WBC 21,600 with 87 polys/4 bands 10/4/07-diagnostic reports received for DOS 9/11-9/12/07-WBC 21.6, Poly 87, Glucose 170, Bilirubin total 1.45, urine ketones 40, mono positive, Blood culture no growth. EBV CAPSID IgM positive.CT abdomen and pelvis trace amount fluid in cul-de-sac, left ovary slightly larger than right. Consistent with mittelschmerz. Leukocytosis 21,600. Amylase 50 and lipase 15. Mono test positive.
CDC 'Split Type':

Write-up: Pt developed abd. pain, vomiting within 1 hr of vaccine administration. Also was lightheaded (dizzy) - evaluated in ER and admitted for IV hydration (dehydrated) 11/6/07-records received for DOS 9/11-9/12/07-DC DX: Vomiting resolved. Dehydration resolved. Admitted with complaint of vomiting and abdominal pain which began yesterday suddenly.


Changed on 6/14/2018

VAERS ID: 291301 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Massachusetts
Vaccinated:2007-09-11
Onset:2007-09-11
Submitted:2007-09-13
Entered:2007-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1062U / 3 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Chest X-ray, Chest X-ray normal, Computerised tomogram abnormal, Dehydration, Dizziness, Full blood count, Urinary system X-ray, Vomiting, White blood cell count increased

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Rx prescribed by pts. GYN to moderate periods.
Current Illness: None
Preexisting Conditions: Idiopathic lower extremity edema
Allergies:
Diagnostic Lab Data: Abd/pelvic CT - small amt fluid in cul-de-sac - o/w negative; - KUB; - CXR; CBC; WBC 21,600 with 87 polys/4 bands 10/4/07-diagnostic reports received for DOS 9/11-9/12/07-WBC 21.6, Poly 87, Glucose 170, Bilirubin total 1.45, urine ketones 40, mono positive, Blood culture no growth. EBV CAPSID IgM positive.CT abdomen and pelvis trace amount fluid in cul-de-sac, left ovary slightly larger than right. Consistent with mittelschmerz. Leukocytosis 21,600. Amylase 50 and lipase 15. Mono test positive.
CDC 'Split Type':

Write-up: Pt developed abd. pain, vomiting within 1 hr of vaccine administration. Also was lightheaded (dizzy) - evaluated in ER and admitted for IV hydration (dehydrated) 11/6/07-records received for DOS 9/11-9/12/07-DC DX: Vomiting resolved. Dehydration resolved. Admitted with complaint of vomiting and abdominal pain which began yesterday suddenly.


Changed on 8/14/2018

VAERS ID: 291301 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Massachusetts
Vaccinated:2007-09-11
Onset:2007-09-11
Submitted:2007-09-13
Entered:2007-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1062U / 3 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Chest X-ray, Chest X-ray normal, Computerised tomogram abnormal, Dehydration, Dizziness, Full blood count, Urinary system X-ray, Vomiting, White blood cell count increased

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Rx prescribed by pts. GYN to moderate periods.
Current Illness: None
Preexisting Conditions: Idiopathic lower extremity edema
Allergies:
Diagnostic Lab Data: Abd/pelvic CT - small amt fluid in cul-de-sac - o/w negative; - KUB; - CXR; CBC; WBC 21,600 with 87 polys/4 bands 10/4/07-diagnostic reports received for DOS 9/11-9/12/07-WBC 21.6, Poly 87, Glucose 170, Bilirubin total 1.45, urine ketones 40, mono positive, Blood culture no growth. EBV CAPSID IgM positive.CT abdomen and pelvis trace amount fluid in cul-de-sac, left ovary slightly larger than right. Consistent with mittelschmerz. Leukocytosis 21,600. Amylase 50 and lipase 15. Mono test positive.
CDC 'Split Type':

Write-up: Pt developed abd. pain, vomiting within 1 hr of vaccine administration. Also was lightheaded (dizzy) - evaluated in ER and admitted for IV hydration (dehydrated) 11/6/07-records received for DOS 9/11-9/12/07-DC DX: Vomiting resolved. Dehydration resolved. Admitted with complaint of vomiting and abdominal pain which began yesterday suddenly.


Changed on 9/14/2018

VAERS ID: 291301 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Massachusetts
Vaccinated:2007-09-11
Onset:2007-09-11
Submitted:2007-09-13
Entered:2007-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1062U / 3 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Chest X-ray, Chest X-ray normal, Computerised tomogram abnormal, Dehydration, Dizziness, Full blood count, Urinary system X-ray, Vomiting, White blood cell count increased

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Rx prescribed by pts. GYN to moderate periods.
Current Illness: None
Preexisting Conditions: Idiopathic lower extremity edema
Allergies:
Diagnostic Lab Data: Abd/pelvic CT - small amt fluid in cul-de-sac - o/w negative; - KUB; - CXR; CBC; WBC 21,600 with 87 polys/4 bands 10/4/07-diagnostic reports received for DOS 9/11-9/12/07-WBC 21.6, Poly 87, Glucose 170, Bilirubin total 1.45, urine ketones 40, mono positive, Blood culture no growth. EBV CAPSID IgM positive.CT abdomen and pelvis trace amount fluid in cul-de-sac, left ovary slightly larger than right. Consistent with mittelschmerz. Leukocytosis 21,600. Amylase 50 and lipase 15. Mono test positive.
CDC 'Split Type':

Write-up: Pt developed abd. pain, vomiting within 1 hr of vaccine administration. Also was lightheaded (dizzy) - evaluated in ER and admitted for IV hydration (dehydrated) 11/6/07-records received for DOS 9/11-9/12/07-DC DX: Vomiting resolved. Dehydration resolved. Admitted with complaint of vomiting and abdominal pain which began yesterday suddenly.


Changed on 10/14/2018

VAERS ID: 291301 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Massachusetts
Vaccinated:2007-09-11
Onset:2007-09-11
Submitted:2007-09-13
Entered:2007-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1062U / 3 RA / IM

Administered by: Private      Purchased by: Public
Symptoms: Abdominal pain, Chest X-ray, Chest X-ray normal, Computerised tomogram abnormal, Dehydration, Dizziness, Full blood count, Urinary system X-ray, Vomiting, White blood cell count increased

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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Rx prescribed by pts. GYN to moderate periods.
Current Illness: None
Preexisting Conditions: Idiopathic lower extremity edema
Allergies:
Diagnostic Lab Data: Abd/pelvic CT - small amt fluid in cul-de-sac - o/w negative; - KUB; - CXR; CBC; WBC 21,600 with 87 polys/4 bands 10/4/07-diagnostic reports received for DOS 9/11-9/12/07-WBC 21.6, Poly 87, Glucose 170, Bilirubin total 1.45, urine ketones 40, mono positive, Blood culture no growth. EBV CAPSID IgM positive.CT abdomen and pelvis trace amount fluid in cul-de-sac, left ovary slightly larger than right. Consistent with mittelschmerz. Leukocytosis 21,600. Amylase 50 and lipase 15. Mono test positive.
CDC 'Split Type':

Write-up: Pt developed abd. pain, vomiting within 1 hr of vaccine administration. Also was lightheaded (dizzy) - evaluated in ER and admitted for IV hydration (dehydrated) 11/6/07-records received for DOS 9/11-9/12/07-DC DX: Vomiting resolved. Dehydration resolved. Admitted with complaint of vomiting and abdominal pain which began yesterday suddenly.

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