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This is VAERS ID 292483

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

VAERS ID: 292483
VAERS Form:
Age:16.0
Gender:Female
Location:Wisconsin
Vaccinated:2007-08-17
Onset:2007-09-28
Submitted:2007-10-08
Entered:2007-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 02464 / 0 LA / UN
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR 62331AA / 0 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 08474 / 1 LA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Affective disorder, Blood cholesterol increased, Blood triglycerides increased, Borderline personality disorder, Depression

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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LITHOBID 600mg BID, EFFEXOR XR 112.5mg QD, ABILIFY 10mg daily
Current Illness:
Preexisting Conditions: ADHD, Bipolar, Turette''s
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Labs WNL except Cholesterol 204 and Triglycerides 183.
CDC 'Split Type':

Write-up: 42 days after administration of Gardasil #1 and 42 days after administration of Gardasil #2 this child attempted suicide.


Changed on 12/8/2009

VAERS ID: 292483 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Wisconsin
Vaccinated:2007-08-17
Onset:2007-09-28
Submitted:2007-10-08
Entered:2007-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 02464 / 0 LA / UN
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR 62331AA / 0 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 08474 / 1 LA / UN

Administered by: Private      Purchased by: Unknown Private
Symptoms: Affective disorder, Blood cholesterol increased, Blood triglycerides increased, Borderline personality disorder, Depression, Intentional self-injury, Overdose, Personality disorder, Reactive attachment disorder of infancy or early childhood, Suicide attempt, Self-injurious ideation, Vaccine positive rechallenge

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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LITHOBID 600mg BID, EFFEXOR XR 112.5mg QD, ABILIFY 10mg daily
Current Illness:
Preexisting Conditions: ADHD, Bipolar, Turette''s Turette''s. PMH: Tourette Syndrome. Repeated inpatient psychiatric stays 2'' to depression. Allergy to Lexapro.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Labs WNL except Cholesterol 204 and Triglycerides 183.
CDC 'Split Type':

Write-up: 42 days after administration of Gardasil #1 and 42 days after administration of Gardasil #2 this child attempted suicide. 11/08/2007 MR received for DOS 7/25-31/2007 for D/C DX Depressive Disorder NOS, Mood Disorder NOS, ADHD, and Reactive Attachment Disorder R/O Borderline S/P overdose with Tylenol and DOS 10/4-12/2007 with DX: Depression, NOS. Mood disorder. Very strong traits of borderline personality disorder, superficial cuts, self inflicted. Pt was admitted to hospital on 7/25/07 after recent attempted suicide by overdosing with Tylenol. Improvement during hospital stay however struggling with self-harming behavior. Readmitted 10/4/07 after engaging in self abusive and self destructive behavior. Carved 666 on leg and was popping pills wanting to kill herself. Pt remained at risk for self harming upon D/C. Per 60 day follow up: Pt was referred for two suicide attempts after GARDASIL. Pt was depressed before episodes, and remains in treatment for depression, etc. causation unclear.


Changed on 1/5/2010

VAERS ID: 292483 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Wisconsin
Vaccinated:2007-08-17
Onset:2007-09-28
Submitted:2007-10-08
Entered:2007-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 02464 / 0 LA / UN
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR 62331AA / 0 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 08474 / 1 LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Affective disorder, Blood cholesterol increased, Blood triglycerides increased, Borderline personality disorder, Depression, Intentional self-injury, Overdose, Personality disorder, Reactive attachment disorder of infancy or early childhood, Suicide attempt, Self-injurious ideation, Vaccine positive rechallenge

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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LITHOBID 600mg BID, EFFEXOR XR 112.5mg QD, ABILIFY 10mg daily
Current Illness:
Preexisting Conditions: ADHD, Bipolar, Turette''s. PMH: Tourette Syndrome. Repeated inpatient psychiatric stays 2'' to depression. Allergy to Lexapro.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Labs WNL except Cholesterol 204 and Triglycerides 183.
CDC 'Split Type':

Write-up: 42 days after administration of Gardasil #1 and 42 days after administration of Gardasil #2 this child attempted suicide. 11/08/2007 MR received for DOS 7/25-31/2007 for D/C DX Depressive Disorder NOS, Mood Disorder NOS, ADHD, and Reactive Attachment Disorder R/O Borderline S/P overdose with Tylenol and DOS 10/4-12/2007 with DX: Depression, NOS. Mood disorder. Very strong traits of borderline personality disorder, superficial cuts, self inflicted. Pt was admitted to hospital on 7/25/07 after recent attempted suicide by overdosing with Tylenol. Improvement during hospital stay however struggling with self-harming behavior. Readmitted 10/4/07 after engaging in self abusive and self destructive behavior. Carved 666 on leg and was popping pills wanting to kill herself. Pt remained at risk for self harming upon D/C. Per 60 day follow up: Pt was referred for two suicide attempts after GARDASIL. Pt was depressed before episodes, and remains in treatment for depression, etc. causation unclear. 1/12/2010 Still has mood disorder (bipolar) and Tlc disvrei refraction to meds. She is a cutter.


Changed on 4/7/2010

VAERS ID: 292483 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Wisconsin
Vaccinated:2007-08-17
Onset:2007-09-28
Submitted:2007-10-08
Entered:2007-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 02464 / 0 LA / UN
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR 62331AA / 0 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 08474 / 1 LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Suicide attempt

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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LITHOBID 600mg BID, EFFEXOR XR 112.5mg QD, ABILIFY 10mg daily
Current Illness:
Preexisting Conditions: ADHD, Bipolar, Turette''s. PMH: Tourette Syndrome. Repeated inpatient psychiatric stays 2'' to depression. Allergy to Lexapro.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Labs WNL except Cholesterol 204 and Triglycerides 183.
CDC 'Split Type':

Write-up: 42 days after administration of Gardasil #1 and 42 days after administration of Gardasil #2 this child attempted suicide. 11/08/2007 MR received for DOS 7/25-31/2007 for D/C DX Depressive Disorder NOS, Mood Disorder NOS, ADHD, and Reactive Attachment Disorder R/O Borderline S/P overdose with Tylenol and DOS 10/4-12/2007 with DX: Depression, NOS. Mood disorder. Very strong traits of borderline personality disorder, superficial cuts, self inflicted. Pt was admitted to hospital on 7/25/07 after recent attempted suicide by overdosing with Tylenol. Improvement during hospital stay however struggling with self-harming behavior. Readmitted 10/4/07 after engaging in self abusive and self destructive behavior. Carved 666 on leg and was popping pills wanting to kill herself. Pt remained at risk for self harming upon D/C. Per 60 day follow up: Pt was referred for two suicide attempts after GARDASIL. Pt was depressed before episodes, and remains in treatment for depression, etc. causation unclear. 1/12/2010 Still has mood disorder (bipolar) and Tlc disvrei refraction to meds. She is a cutter.


Changed on 7/31/2010

VAERS ID: 292483 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Wisconsin
Vaccinated:2007-08-17
Onset:2007-09-28
Submitted:2007-10-08
Entered:2007-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 02464 / 0 LA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR 62331AA / 0 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 08474 / 1 LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Attention deficit/hyperactivity disorder, Personality disorder, Suicide attempt, Vaccine positive rechallenge

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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LITHOBID 600mg BID, EFFEXOR XR 112.5mg QD, ABILIFY 10mg daily
Current Illness:
Preexisting Conditions: ADHD, Bipolar, Turette''s. PMH: Tourette Syndrome. Repeated inpatient psychiatric stays 2'' to depression. Allergy to Lexapro.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Labs WNL except Cholesterol 204 and Triglycerides 183.
CDC 'Split Type':

Write-up: 42 days after administration of Gardasil #1 and 42 days after administration of Gardasil #2 this child attempted suicide. 11/08/2007 MR received for DOS 7/25-31/2007 for D/C DX Depressive Disorder NOS, Mood Disorder NOS, ADHD, and Reactive Attachment Disorder R/O Borderline S/P overdose with Tylenol and DOS 10/4-12/2007 with DX: Depression, NOS. Mood disorder. Very strong traits of borderline personality disorder, superficial cuts, self inflicted. Pt was admitted to hospital on 7/25/07 after recent attempted suicide by overdosing with Tylenol. Improvement during hospital stay however struggling with self-harming behavior. Readmitted 10/4/07 after engaging in self abusive and self destructive behavior. Carved 666 on leg and was popping pills wanting to kill herself. Pt remained at risk for self harming upon D/C. Per 60 day follow up: Pt was referred for two suicide attempts after GARDASIL. Pt was depressed before episodes, and remains in treatment for depression, etc. causation unclear. 1/12/2010 Still has mood disorder (bipolar) and Tlc disvrei refraction to meds. She is a cutter.


Changed on 4/13/2011

VAERS ID: 292483 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Wisconsin
Vaccinated:2007-08-17
Onset:2007-09-28
Submitted:2007-10-08
Entered:2007-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 02464 / 0 LA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR 62331AA / 0 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 08474 / 1 LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Affective disorder, Attention deficit/hyperactivity disorder, Blood cholesterol increased, Blood triglycerides increased, Borderline personality disorder, Depression, Intentional self-injury, Overdose, Personality disorder, Reactive attachment disorder of infancy or early childhood, Suicide attempt, Self-injurious ideation, Vaccine positive rechallenge

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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LITHOBID 600mg BID, EFFEXOR XR 112.5mg QD, ABILIFY 10mg daily
Current Illness:
Preexisting Conditions: ADHD, Bipolar, Turette''s. PMH: Tourette Syndrome. Repeated inpatient psychiatric stays 2'' to depression. Allergy to Lexapro.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Labs WNL except Cholesterol 204 and Triglycerides 183.
CDC 'Split Type':

Write-up: 42 days after administration of Gardasil #1 and 42 days after administration of Gardasil #2 this child attempted suicide. 11/08/2007 MR received for DOS 7/25-31/2007 for D/C DX Depressive Disorder NOS, Mood Disorder NOS, ADHD, and Reactive Attachment Disorder R/O Borderline S/P overdose with Tylenol and DOS 10/4-12/2007 with DX: Depression, NOS. Mood disorder. Very strong traits of borderline personality disorder, superficial cuts, self inflicted. Pt was admitted to hospital on 7/25/07 after recent attempted suicide by overdosing with Tylenol. Improvement during hospital stay however struggling with self-harming behavior. Readmitted 10/4/07 after engaging in self abusive and self destructive behavior. Carved 666 on leg and was popping pills wanting to kill herself. Pt remained at risk for self harming upon D/C. Per 60 day follow up: Pt was referred for two suicide attempts after GARDASIL. Pt was depressed before episodes, and remains in treatment for depression, etc. causation unclear. 1/12/2010 Still has mood disorder (bipolar) and Tlc disvrei refraction to meds. She is a cutter.


Changed on 5/13/2011

VAERS ID: 292483 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Wisconsin
Vaccinated:2007-08-17
Onset:2007-09-28
Submitted:2007-10-08
Entered:2007-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 02464 / 0 LA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR 62331AA / 0 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 08474 / 1 LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Affective disorder, Attention deficit/hyperactivity disorder, Blood cholesterol increased, Blood triglycerides increased, Borderline personality disorder, Depression, Intentional self-injury, Overdose, Personality disorder, Reactive attachment disorder of infancy or early childhood, Suicide attempt, Self-injurious ideation, Vaccine positive rechallenge

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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LITHOBID 600mg BID, EFFEXOR XR 112.5mg QD, ABILIFY 10mg daily
Current Illness:
Preexisting Conditions: ADHD, Bipolar, Turette''s. PMH: Tourette Syndrome. Repeated inpatient psychiatric stays 2'' to depression. Allergy to Lexapro.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Labs WNL except Cholesterol 204 and Triglycerides 183.
CDC 'Split Type':

Write-up: 42 days after administration of Gardasil #1 and 42 days after administration of Gardasil #2 this child attempted suicide. 11/08/2007 MR received for DOS 7/25-31/2007 for D/C DX Depressive Disorder NOS, Mood Disorder NOS, ADHD, and Reactive Attachment Disorder R/O Borderline S/P overdose with Tylenol and DOS 10/4-12/2007 with DX: Depression, NOS. Mood disorder. Very strong traits of borderline personality disorder, superficial cuts, self inflicted. Pt was admitted to hospital on 7/25/07 after recent attempted suicide by overdosing with Tylenol. Improvement during hospital stay however struggling with self-harming behavior. Readmitted 10/4/07 after engaging in self abusive and self destructive behavior. Carved 666 on leg and was popping pills wanting to kill herself. Pt remained at risk for self harming upon D/C. Per 60 day follow up: Pt was referred for two suicide attempts after GARDASIL. Pt was depressed before episodes, and remains in treatment for depression, etc. causation unclear. 1/12/2010 Still has mood disorder (bipolar) and Tlc disvrei refraction to meds. She is a cutter.


Changed on 6/11/2011

VAERS ID: 292483 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Wisconsin
Vaccinated:2007-08-17
Onset:2007-09-28
Submitted:2007-10-08
Entered:2007-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 02464 / 0 LA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR 62331AA / 0 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 08474 / 1 LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Affective disorder, Attention deficit/hyperactivity disorder, Blood cholesterol increased, Blood triglycerides increased, Borderline personality disorder, Depression, Intentional self-injury, Overdose, Personality disorder, Reactive attachment disorder of infancy or early childhood, Suicide attempt, Self-injurious ideation, Vaccine positive rechallenge

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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LITHOBID 600mg BID, EFFEXOR XR 112.5mg QD, ABILIFY 10mg daily
Current Illness:
Preexisting Conditions: ADHD, Bipolar, Turette''s. PMH: Tourette Syndrome. Repeated inpatient psychiatric stays 2'' to depression. Allergy to Lexapro.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Labs WNL except Cholesterol 204 and Triglycerides 183.
CDC 'Split Type':

Write-up: 42 days after administration of Gardasil #1 and 42 days after administration of Gardasil #2 this child attempted suicide. 11/08/2007 MR received for DOS 7/25-31/2007 for D/C DX Depressive Disorder NOS, Mood Disorder NOS, ADHD, and Reactive Attachment Disorder R/O Borderline S/P overdose with Tylenol and DOS 10/4-12/2007 with DX: Depression, NOS. Mood disorder. Very strong traits of borderline personality disorder, superficial cuts, self inflicted. Pt was admitted to hospital on 7/25/07 after recent attempted suicide by overdosing with Tylenol. Improvement during hospital stay however struggling with self-harming behavior. Readmitted 10/4/07 after engaging in self abusive and self destructive behavior. Carved 666 on leg and was popping pills wanting to kill herself. Pt remained at risk for self harming upon D/C. Per 60 day follow up: Pt was referred for two suicide attempts after GARDASIL. Pt was depressed before episodes, and remains in treatment for depression, etc. causation unclear. 1/12/2010 Still has mood disorder (bipolar) and Tlc disvrei refraction to meds. She is a cutter.


Changed on 6/14/2014

VAERS ID: 292483 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Wisconsin
Vaccinated:2007-08-17
Onset:2007-09-28
Submitted:2007-10-08
Entered:2007-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 02464 / 0 LA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR 62331AA / 0 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 08474 / 1 LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Affective disorder, Attention deficit/hyperactivity disorder, Blood cholesterol increased, Blood triglycerides increased, Borderline personality disorder, Depression, Intentional self-injury, Overdose, Personality disorder, Reactive attachment disorder of infancy or early childhood, Suicide attempt, Self-injurious ideation, Vaccine positive rechallenge

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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LITHOBID 600mg BID, EFFEXOR XR 112.5mg QD, ABILIFY 10mg daily
Current Illness:
Preexisting Conditions: ADHD, Bipolar, Turette''s. PMH: Tourette Syndrome. Repeated inpatient psychiatric stays 2'' to depression. Allergy to Lexapro.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Labs WNL except Cholesterol 204 and Triglycerides 183.
CDC 'Split Type':

Write-up: 42 days after administration of Gardasil #1 and 42 days after administration of Gardasil #2 this child attempted suicide. 11/08/2007 MR received for DOS 7/25-31/2007 for D/C DX Depressive Disorder NOS, Mood Disorder NOS, ADHD, and Reactive Attachment Disorder R/O Borderline S/P overdose with Tylenol and DOS 10/4-12/2007 with DX: Depression, NOS. Mood disorder. Very strong traits of borderline personality disorder, superficial cuts, self inflicted. Pt was admitted to hospital on 7/25/07 after recent attempted suicide by overdosing with Tylenol. Improvement during hospital stay however struggling with self-harming behavior. Readmitted 10/4/07 after engaging in self abusive and self destructive behavior. Carved 666 on leg and was popping pills wanting to kill herself. Pt remained at risk for self harming upon D/C. Per 60 day follow up: Pt was referred for two suicide attempts after GARDASIL. Pt was depressed before episodes, and remains in treatment for depression, etc. causation unclear. 1/12/2010 Still has mood disorder (bipolar) and Tlc disvrei refraction to meds. She is a cutter.


Changed on 4/14/2017

VAERS ID: 292483 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Wisconsin
Vaccinated:2007-08-17
Onset:2007-09-28
Submitted:2007-10-08
Entered:2007-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 02464 / 0 LA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR 62331AA / 0 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 08474 / 1 LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Affective disorder, Attention deficit/hyperactivity disorder, Blood cholesterol increased, Blood triglycerides increased, Borderline personality disorder, Depression, Intentional self-injury, Overdose, Personality disorder, Reactive attachment disorder of infancy or early childhood, Suicide attempt, Self-injurious ideation, Vaccine positive rechallenge

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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LITHOBID 600mg BID, EFFEXOR XR 112.5mg QD, ABILIFY 10mg daily
Current Illness:
Preexisting Conditions: ADHD, Bipolar, Turette''s. PMH: Tourette Syndrome. Repeated inpatient psychiatric stays 2'' to depression. Allergy to Lexapro.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Labs WNL except Cholesterol 204 and Triglycerides 183.
CDC 'Split Type':

Write-up: 42 days after administration of Gardasil #1 and 42 days after administration of Gardasil #2 this child attempted suicide. 11/08/2007 MR received for DOS 7/25-31/2007 for D/C DX Depressive Disorder NOS, Mood Disorder NOS, ADHD, and Reactive Attachment Disorder R/O Borderline S/P overdose with Tylenol and DOS 10/4-12/2007 with DX: Depression, NOS. Mood disorder. Very strong traits of borderline personality disorder, superficial cuts, self inflicted. Pt was admitted to hospital on 7/25/07 after recent attempted suicide by overdosing with Tylenol. Improvement during hospital stay however struggling with self-harming behavior. Readmitted 10/4/07 after engaging in self abusive and self destructive behavior. Carved 666 on leg and was popping pills wanting to kill herself. Pt remained at risk for self harming upon D/C. Per 60 day follow up: Pt was referred for two suicide attempts after GARDASIL. Pt was depressed before episodes, and remains in treatment for depression, etc. causation unclear. 1/12/2010 Still has mood disorder (bipolar) and Tlc disvrei refraction to meds. She is a cutter.


Changed on 9/14/2017

VAERS ID: 292483 Before After
VAERS Form:(blank) 1
Age:16.0
Gender:Female
Location:Wisconsin
Vaccinated:2007-08-17
Onset:2007-09-28
Submitted:2007-10-08
Entered:2007-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 02464 / 0 1 LA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR 62331AA / 0 1 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 08474 / 1 2 LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Attention deficit/hyperactivity disorder, Personality disorder, Suicide attempt, Vaccine positive rechallenge

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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LITHOBID 600mg BID, EFFEXOR XR 112.5mg QD, ABILIFY 10mg daily
Current Illness:
Preexisting Conditions: ADHD, Bipolar, Turette''s. PMH: Tourette Syndrome. Repeated inpatient psychiatric stays 2'' to depression. Allergy to Lexapro.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Labs WNL except Cholesterol 204 and Triglycerides 183.
CDC 'Split Type':

Write-up: 42 days after administration of Gardasil #1 and 42 days after administration of Gardasil #2 this child attempted suicide. 11/08/2007 MR received for DOS 7/25-31/2007 for D/C DX Depressive Disorder NOS, Mood Disorder NOS, ADHD, and Reactive Attachment Disorder R/O Borderline S/P overdose with Tylenol and DOS 10/4-12/2007 with DX: Depression, NOS. Mood disorder. Very strong traits of borderline personality disorder, superficial cuts, self inflicted. Pt was admitted to hospital on 7/25/07 after recent attempted suicide by overdosing with Tylenol. Improvement during hospital stay however struggling with self-harming behavior. Readmitted 10/4/07 after engaging in self abusive and self destructive behavior. Carved 666 on leg and was popping pills wanting to kill herself. Pt remained at risk for self harming upon D/C. Per 60 day follow up: Pt was referred for two suicide attempts after GARDASIL. Pt was depressed before episodes, and remains in treatment for depression, etc. causation unclear. 1/12/2010 Still has mood disorder (bipolar) and Tlc disvrei refraction to meds. She is a cutter.


Changed on 2/14/2018

VAERS ID: 292483 Before After
VAERS Form:1
Age:16.0
Gender:Female
Location:Wisconsin
Vaccinated:2007-08-17
Onset:2007-09-28
Submitted:2007-10-08
Entered:2007-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 02464 / 1 LA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR 62331AA / 1 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 08474 / 2 LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Attention deficit/hyperactivity disorder, Personality disorder, Suicide attempt, Vaccine positive rechallenge

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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LITHOBID 600mg BID, EFFEXOR XR 112.5mg QD, ABILIFY 10mg daily
Current Illness:
Preexisting Conditions: ADHD, Bipolar, Turette''s. PMH: Tourette Syndrome. Repeated inpatient psychiatric stays 2'' to depression. Allergy to Lexapro.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Labs WNL except Cholesterol 204 and Triglycerides 183.
CDC 'Split Type':

Write-up: 42 days after administration of Gardasil #1 and 42 days after administration of Gardasil #2 this child attempted suicide. 11/08/2007 MR received for DOS 7/25-31/2007 for D/C DX Depressive Disorder NOS, Mood Disorder NOS, ADHD, and Reactive Attachment Disorder R/O Borderline S/P overdose with Tylenol and DOS 10/4-12/2007 with DX: Depression, NOS. Mood disorder. Very strong traits of borderline personality disorder, superficial cuts, self inflicted. Pt was admitted to hospital on 7/25/07 after recent attempted suicide by overdosing with Tylenol. Improvement during hospital stay however struggling with self-harming behavior. Readmitted 10/4/07 after engaging in self abusive and self destructive behavior. Carved 666 on leg and was popping pills wanting to kill herself. Pt remained at risk for self harming upon D/C. Per 60 day follow up: Pt was referred for two suicide attempts after GARDASIL. Pt was depressed before episodes, and remains in treatment for depression, etc. causation unclear. 1/12/2010 Still has mood disorder (bipolar) and Tlc disvrei refraction to meds. She is a cutter.


Changed on 6/14/2018

VAERS ID: 292483 Before After
VAERS Form:1
Age:16.0
Gender:Female
Location:Wisconsin
Vaccinated:2007-08-17
Onset:2007-09-28
Submitted:2007-10-08
Entered:2007-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 02464 / 1 LA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR 62331AA / 1 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 08474 / 2 LA / UN

Administered by: Private      Purchased by: Private
Symptoms: Attention deficit/hyperactivity disorder, Personality disorder, Suicide attempt, Vaccine positive rechallenge

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: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LITHOBID 600mg BID, EFFEXOR XR 112.5mg QD, ABILIFY 10mg daily
Current Illness:
Preexisting Conditions: ADHD, Bipolar, Turette''s. PMH: Tourette Syndrome. Repeated inpatient psychiatric stays 2'' to depression. Allergy to Lexapro.
Allergies:
Diagnostic Lab Data: Labs and Diagnostics: Labs WNL except Cholesterol 204 and Triglycerides 183.
CDC 'Split Type':

Write-up: 42 days after administration of Gardasil #1 and 42 days after administration of Gardasil #2 this child attempted suicide. 11/08/2007 MR received for DOS 7/25-31/2007 for D/C DX Depressive Disorder NOS, Mood Disorder NOS, ADHD, and Reactive Attachment Disorder R/O Borderline S/P overdose with Tylenol and DOS 10/4-12/2007 with DX: Depression, NOS. Mood disorder. Very strong traits of borderline personality disorder, superficial cuts, self inflicted. Pt was admitted to hospital on 7/25/07 after recent attempted suicide by overdosing with Tylenol. Improvement during hospital stay however struggling with self-harming behavior. Readmitted 10/4/07 after engaging in self abusive and self destructive behavior. Carved 666 on leg and was popping pills wanting to kill herself. Pt remained at risk for self harming upon D/C. Per 60 day follow up: Pt was referred for two suicide attempts after GARDASIL. Pt was depressed before episodes, and remains in treatment for depression, etc. causation unclear. 1/12/2010 Still has mood disorder (bipolar) and Tlc disvrei refraction to meds. She is a cutter.

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