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This is VAERS ID 300497

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2007

300497
VAERS Form:
Age:15.0
Gender:Female
Location:Virginia
Vaccinated:2007-10-11
Onset:2007-10-21
Submitted:2007-12-14
Entered:2007-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / UN

Administered by: Other      Purchased by: Unknown
Symptoms: Back pain, Chest pain, Full blood count, Activities of daily living impaired, Borrelia burgdorferi serology

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: Penicillin allergy; Sulfonamide allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: complete blood cell - no provided; erythrocyte - not provided; Lyme disease assay - not provided; serum rheumatoid factor - not provided
CDC 'Split Type':

Write-up:Information has been received from a pharmacist concerning her 15 year old daughter who plays sports, with a penicillin allergy and sulfonamide allergy and no pertinent medical history who in August 2007, was vaccinated with her first dose of Gardasil. On"11-OCT-2007 the patient received her second dose of Gardasil. On 21-OCT-2007, ten days after receiving her second dose, the patient developed myalgia. The patient had unexplained muscle pain which started from her shoulder and traveled to her back and the


Changed on 12/8/2009

300497 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Virginia
Vaccinated:2007-10-11
Onset:2007-10-21
Submitted:2007-12-14
Entered:2007-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / UN

Administered by: Other      Purchased by: Unknown Other
Symptoms: Back pain, Chest pain, Full blood count, Musculoskeletal pain, Myalgia, Rheumatoid factor, Red blood cell sedimentation rate, Activities of daily living impaired, Borrelia burgdorferi serology

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: Penicillin allergy; Sulfonamide allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: complete blood cell - no provided; erythrocyte - not provided; Lyme disease assay - not provided; serum rheumatoid factor - not provided
CDC 'Split Type': (blank) WAES0711USA04684

Write-up:Information has been received from a pharmacist concerning her 15 year old daughter who plays sports, with a penicillin allergy and sulfonamide allergy and no pertinent medical history who in August 2007, was vaccinated with her first dose of Gardasil. On"11-OCT-2007 On 11-OCT-2007 the patient received her second dose of Gardasil. On 21-OCT-2007, ten days after receiving her second dose, the patient developed myalgia. The patient had unexplained muscle pain which started from her shoulder and traveled to her back and then to her chest. This event was considered to be a significant disability, as she was not able to play basketball. Laboratory tests included: complete blood count, sedimentation rate, lyme disease titer, and a rheumatoid arthritis test (results not reported). The patient''s myalgia persisted. Medical attention was sought, the patient saw the physician. Additional information has been requested.


Changed on 9/14/2017

300497 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:Virginia
Vaccinated:2007-10-11
Onset:2007-10-21
Submitted:2007-12-14
Entered:2007-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Back pain, Chest pain, Full blood count, Musculoskeletal pain, Myalgia, Rheumatoid factor, Red blood cell sedimentation rate, Activities of daily living impaired, Borrelia burgdorferi serology

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: Penicillin allergy; Sulfonamide allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: complete blood cell - no provided; erythrocyte - not provided; Lyme disease assay - not provided; serum rheumatoid factor - not provided
CDC 'Split Type': WAES0711USA04684

Write-up:Information has been received from a pharmacist concerning her 15 year old daughter who plays sports, with a penicillin allergy and sulfonamide allergy and no pertinent medical history who in August 2007, was vaccinated with her first dose of Gardasil. On 11-OCT-2007 the patient received her second dose of Gardasil. On 21-OCT-2007, ten days after receiving her second dose, the patient developed myalgia. The patient had unexplained muscle pain which started from her shoulder and traveled to her back and then to her chest. This event was considered to be a significant disability, as she was not able to play basketball. Laboratory tests included: complete blood count, sedimentation rate, lyme disease titer, and a rheumatoid arthritis test (results not reported). The patient''s myalgia persisted. Medical attention was sought, the patient saw the physician. Additional information has been requested.


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