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This is VAERS ID 296065

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

296065
VAERS Form:
Age:16.0
Gender:Female
Location:Idaho
Vaccinated:2007-10-12
Onset:2007-10-17
Submitted:2007-11-07
Entered:2007-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0927U / 0 UN / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Headache, Nausea, Paraesthesia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up:Information has been received from a physician''''s assistant concerning a 15 year old female who on approximately 17-OCT-2007 was vaccinated with a 0.5 ml dose of Gardasil. On approximately 17-OCT-2007 the patient experienced headache, extreme nausea, vomi"ting and tingling in fingers and toes. It was reported that the patient missed 2 days of school. At the time of the report, the patient was recovering. The reporting physician''''s assistant considered headache, extreme nausea, vomiting and tingling in fing


Changed on 12/8/2009

296065 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Idaho
Vaccinated:2007-10-12
Onset:2007-10-17
Submitted:2007-11-07
Entered:2007-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0927U / 0 UN / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Bronchitis, Cough, Headache, Nausea, Otitis externa, Otitis media, Paraesthesia, Pharyngolaryngeal pain, Upper respiratory tract infection, Vomiting, Activities of daily living impaired

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: recurrent otitis media & otitis externa. Depression, self mutilation & prior suicide attempts. Childhood sexual abuse & rape w/flashbacks. Mildly obese. Allergic: sulfa. MVA 3 yrs prior w/lingering HA.
Allergies:
Diagnostic Lab Data: Unknown LABS: abnormal Pap smear 10/30. CBC, chemistry & thyroid WNL.
CDC 'Split Type': (blank) WAES0710USA05278

Write-up:Information has been received from a physician''''s physician''s assistant concerning a 15 year old female who on approximately 17-OCT-2007 was vaccinated with a 0.5 ml dose of Gardasil. On approximately 17-OCT-2007 the patient experienced headache, extreme nausea, vomi"ting vomiting and tingling in fingers and toes. It was reported that the patient missed 2 days of school. At the time of the report, the patient was recovering. The reporting physician''''s physician''s assistant considered headache, extreme nausea, vomiting and tingling in fing fingers and toes to be disabling. Additional information has been requested. 11/27/07 Received vax record from pcp. 2/8/08 Reviewed pcp medical records which reveal patient experienced URI s/s, cough, sore throat, bronchitis, otitis media & otitis externa approx 2 wks prior to vax & was on antibiotics. Seen in office 10/16 c/o HA & nausea beginning 48 hr s/p vax. Improved when seen next on 10/23 but bilat otitis externa had recurred.


Changed on 4/14/2017

296065 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Idaho
Vaccinated:2007-10-12
Onset:2007-10-17
Submitted:2007-11-07
Entered:2007-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0927U / 0 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Bronchitis, Cough, Headache, Nausea, Otitis externa, Otitis media, Paraesthesia, Pharyngolaryngeal pain, Upper respiratory tract infection, Vomiting, Activities of daily living impaired

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: recurrent otitis media & otitis externa. Depression, self mutilation & prior suicide attempts. Childhood sexual abuse & rape w/flashbacks. Mildly obese. Allergic: sulfa. MVA 3 yrs prior w/lingering HA.
Allergies:
Diagnostic Lab Data: Unknown LABS: abnormal Pap smear 10/30. CBC, chemistry & thyroid WNL.
CDC 'Split Type': WAES0710USA05278

Write-up:Information has been received from a physician''s assistant concerning a 15 year old female who on approximately 17-OCT-2007 was vaccinated with a 0.5 ml dose of Gardasil. On approximately 17-OCT-2007 the patient experienced headache, extreme nausea, vomiting and tingling in fingers and toes. It was reported that the patient missed 2 days of school. At the time of the report, the patient was recovering. The reporting physician''s assistant considered headache, extreme nausea, vomiting and tingling in fingers and toes to be disabling. Additional information has been requested. 11/27/07 Received vax record from pcp. 2/8/08 Reviewed pcp medical records which reveal patient experienced URI s/s, cough, sore throat, bronchitis, otitis media & otitis externa approx 2 wks prior to vax & was on antibiotics. Seen in office 10/16 c/o HA & nausea beginning 48 hr s/p vax. Improved when seen next on 10/23 but bilat otitis externa had recurred.


Changed on 9/14/2017

296065 Before After
VAERS Form:(blank) 1
Age:16.0
Gender:Female
Location:Idaho
Vaccinated:2007-10-12
Onset:2007-10-17
Submitted:2007-11-07
Entered:2007-11-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0927U / 0 1 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Headache, Nausea, Paraesthesia, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown PMH: recurrent otitis media & otitis externa. Depression, self mutilation & prior suicide attempts. Childhood sexual abuse & rape w/flashbacks. Mildly obese. Allergic: sulfa. MVA 3 yrs prior w/lingering HA.
Allergies:
Diagnostic Lab Data: Unknown LABS: abnormal Pap smear 10/30. CBC, chemistry & thyroid WNL.
CDC 'Split Type': WAES0710USA05278

Write-up:Information has been received from a physician''s assistant concerning a 15 year old female who on approximately 17-OCT-2007 was vaccinated with a 0.5 ml dose of Gardasil. On approximately 17-OCT-2007 the patient experienced headache, extreme nausea, vomiting and tingling in fingers and toes. It was reported that the patient missed 2 days of school. At the time of the report, the patient was recovering. The reporting physician''s assistant considered headache, extreme nausea, vomiting and tingling in fingers and toes to be disabling. Additional information has been requested. 11/27/07 Received vax record from pcp. 2/8/08 Reviewed pcp medical records which reveal patient experienced URI s/s, cough, sore throat, bronchitis, otitis media & otitis externa approx 2 wks prior to vax & was on antibiotics. Seen in office 10/16 c/o HA & nausea beginning 48 hr s/p vax. Improved when seen next on 10/23 but bilat otitis externa had recurred.


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