National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 297034

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

297034
VAERS Form:
Age:15.0
Gender:Female
Location:California
Vaccinated:2007-08-01
Onset:2007-10-01
Submitted:2007-11-15
Entered:2007-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / UN

Administered by: Other      Purchased by: Unknown
Symptoms: Anaemia haemolytic autoimmune, Cold agglutinins positive, Epstein-Barr virus antibody positive, Antinuclear antibody positive, Antibody test positive

Life Threatening? Yes
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? Yes, days: 0     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: diagnostic laboratory - Positive antibodies to Mycoplasma; hemoglobin - 5; Epstein-Barr virus - Positive (IgM); serum ANA - Positive; cold agglutinin test - Positive
CDC 'Split Type':

Write-up:Information has been received from a physician concerning a 15 year old female with no known medical history, drug reactions/allergies or concomitant medication use who at the end of August 2007 (exact date unknown), was vaccinated (site and route not rep"orted) with the 1st dose of Gardasil (dose and lot# not reported). In the beginning of October 2007, the patient became very tired and later jaundiced with a low hemoglobin at 5. Laboratory evaluations revealed IgM positive to Epstein Barr virus, positive


Changed on 12/8/2009

297034 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:California
Vaccinated:2007-08-01
Onset:2007-10-01
Submitted:2007-11-15
Entered:2007-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / UN

Administered by: Other      Purchased by: Unknown Other
Symptoms: Anaemia haemolytic autoimmune, Cold agglutinins positive, Fatigue, Haemoglobin decreased, Jaundice, Epstein-Barr virus antibody positive, Antinuclear antibody positive, Antibody test positive, Mycoplasma serology positive, Transfusion

Life Threatening? Yes
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? Yes, days: 0     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: diagnostic laboratory - Positive antibodies to Mycoplasma; hemoglobin - 5; Epstein-Barr virus - Positive (IgM); serum ANA - Positive; cold agglutinin test - Positive
CDC 'Split Type': (blank) WAES0711USA01791

Write-up:Information has been received from a physician concerning a 15 year old female with no known medical history, drug reactions/allergies or concomitant medication use who at the end of August 2007 (exact date unknown), was vaccinated (site and route not rep"orted) reported) with the 1st dose of Gardasil (dose and lot# not reported). In the beginning of October 2007, the patient became very tired and later jaundiced with a low hemoglobin at 5. Laboratory evaluations revealed IgM positive to Epstein Barr virus, positive cold agglutinins, positive antibodies to mycoplasma and positive antinuclear antibodies (ANA). The patient was admitted to the hospital with Autoimmune Hemolytic Anemia for 2.5 weeks with blood transfusions given. The patient was discharged from the hospital (exact date not reported). The patient had been receiving steroids for approximately one week and was undergoing a steroid taper. The physician felt that the patient''s tiredness, jaundice and Hemolytic Anemia were considered disabling and life threatening and other important medical events. No ongoing hemolysis at the time. At the time of this report the patient was recovering. Additional information has been requested.


Changed on 9/14/2017

297034 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:California
Vaccinated:2007-08-01
Onset:2007-10-01
Submitted:2007-11-15
Entered:2007-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Anaemia haemolytic autoimmune, Cold agglutinins positive, Fatigue, Haemoglobin decreased, Jaundice, Epstein-Barr virus antibody positive, Antinuclear antibody positive, Antibody test positive, Mycoplasma serology positive, Transfusion

Life Threatening? Yes
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? Yes, days: 0     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: diagnostic laboratory - Positive antibodies to Mycoplasma; hemoglobin - 5; Epstein-Barr virus - Positive (IgM); serum ANA - Positive; cold agglutinin test - Positive
CDC 'Split Type': WAES0711USA01791

Write-up:Information has been received from a physician concerning a 15 year old female with no known medical history, drug reactions/allergies or concomitant medication use who at the end of August 2007 (exact date unknown), was vaccinated (site and route not reported) with the 1st dose of Gardasil (dose and lot# not reported). In the beginning of October 2007, the patient became very tired and later jaundiced with a low hemoglobin at 5. Laboratory evaluations revealed IgM positive to Epstein Barr virus, positive cold agglutinins, positive antibodies to mycoplasma and positive antinuclear antibodies (ANA). The patient was admitted to the hospital with Autoimmune Hemolytic Anemia for 2.5 weeks with blood transfusions given. The patient was discharged from the hospital (exact date not reported). The patient had been receiving steroids for approximately one week and was undergoing a steroid taper. The physician felt that the patient''s tiredness, jaundice and Hemolytic Anemia were considered disabling and life threatening and other important medical events. No ongoing hemolysis at the time. At the time of this report the patient was recovering. Additional information has been requested.


New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=297034&WAYBACKHISTORY=ON


Copyright © 2017 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166