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This is VAERS ID 309412

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

309412
VAERS Form:
Age:16.0
Gender:Female
Location:Illinois
Vaccinated:2007-09-05
Onset:2007-09-05
Submitted:2008-04-11
Entered:2008-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1060U / 1 UN / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Abdominal pain, Abdominal tenderness, Blood amylase, Chest X-ray normal, Computerised tomogram abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ACCUTANE
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: x-ray; computed axial; complete blood cell; urinalysis LABS: UA w/1+ total protein, WBC 6-10, RBC 6-20, occ bacteria, c/s neg. CBC, amylase, lipase, ASO, mono & chemistry WNL. ESR 25 (H)CXR WNL. US of gallbladder WNL. CT of abdomen/p
CDC 'Split Type':

Write-up:Information has been received from a registered nurse concerning her 16 year old daughter with no known drug allergies and no medical history reported, who on 04-SEP-2007 was vaccinated intramuscularly with the second dose of Gardasil. Concomitant therapy"included ACCUTANE. On 05-SEP-2007, the patient developed acute abdominal pain /"within 24 hours of the vaccination,/" and was hospitalized for three days. The patient was diagnosed with mesenteric lymphadenitis and was treated with antibiotics and pain me


Changed on 12/8/2009

309412 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Illinois
Vaccinated:2007-09-05
Onset:2007-09-05
Submitted:2008-04-11
Entered:2008-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1060U / 1 UN / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Abdominal pain, Abdominal tenderness, Blood amylase, Chest X-ray normal, Computerised tomogram abnormal, Culture urine negative, Full blood count, Full blood count normal, Lipase normal, Lymphadenitis, Mononucleosis heterophile test negative, Ovarian cyst, Pain, Pyrexia, Red blood cell sedimentation rate increased, Laboratory test normal, Ultrasound scan normal, Urine analysis abnormal, Streptococcus identification test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ACCUTANE
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: x-ray; computed axial; complete blood cell; urinalysis LABS: UA w/1+ total protein, WBC 6-10, RBC 6-20, occ bacteria, c/s neg. CBC, amylase, lipase, ASO, mono & chemistry WNL. ESR 25 (H)CXR WNL. US of gallbladder WNL. CT of abdomen/p
CDC 'Split Type': (blank) WAES0804USA00372

Write-up:Information has been received from a registered nurse concerning her 16 year old daughter with no known drug allergies and no medical history reported, who on 04-SEP-2007 was vaccinated intramuscularly with the second dose of Gardasil. Concomitant therapy"included therapy included ACCUTANE. On 05-SEP-2007, the patient developed acute abdominal pain /"within "within 24 hours of the vaccination,/" vaccination," and was hospitalized for three days. The patient was diagnosed with mesenteric lymphadenitis and was treated with antibiotics and pain me medications. Diagnostic laboratory studies performed, with no results reported, included: complete blood cell count, urine test, x-ray and computed axial tomography. On 09-SEP-2007 the patient recovered and was released from the hospital. No product quality complaint was involved. Mesenteric lymphadenitis was considered to be disabling and an other important medical event. Additional information has been requested. 5/2/08 Reviewed hospital medical records of 9/7-9/8/07. FINAL DX: non provided, no d/c summary available. Records reveal patient experienced fever, generalized body aches & achy abdominal pain x 1 day, worse on deep inspiration, better if lying down. Exam revealed tenderness RUQ & RLQ. Admitted for observation. GYN & surgical consults done. D/C to home.


Changed on 4/14/2017

309412 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Illinois
Vaccinated:2007-09-05
Onset:2007-09-05
Submitted:2008-04-11
Entered:2008-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1060U / 1 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Abdominal tenderness, Blood amylase, Chest X-ray normal, Computerised tomogram abnormal, Culture urine negative, Full blood count, Full blood count normal, Lipase normal, Lymphadenitis, Mononucleosis heterophile test negative, Ovarian cyst, Pain, Pyrexia, Red blood cell sedimentation rate increased, Laboratory test normal, Ultrasound scan normal, Urine analysis abnormal, Streptococcus identification test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ACCUTANE
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: x-ray; computed axial; complete blood cell; urinalysis LABS: UA w/1+ total protein, WBC 6-10, RBC 6-20, occ bacteria, c/s neg. CBC, amylase, lipase, ASO, mono & chemistry WNL. ESR 25 (H)CXR WNL. US of gallbladder WNL. CT of abdomen/p abdomen/pelvis mildly prominent lymph nodes in RLQ & small left ovarian cyst c/w simple mid-cycle ovulation cyst.
CDC 'Split Type': WAES0804USA00372

Write-up:Information has been received from a registered nurse concerning her 16 year old daughter with no known drug allergies and no medical history reported, who on 04-SEP-2007 was vaccinated intramuscularly with the second dose of Gardasil. Concomitant therapy included ACCUTANE. On 05-SEP-2007, the patient developed acute abdominal pain "within 24 hours of the vaccination," and was hospitalized for three days. The patient was diagnosed with mesenteric lymphadenitis and was treated with antibiotics and pain medications. Diagnostic laboratory studies performed, with no results reported, included: complete blood cell count, urine test, x-ray and computed axial tomography. On 09-SEP-2007 the patient recovered and was released from the hospital. No product quality complaint was involved. Mesenteric lymphadenitis was considered to be disabling and an other important medical event. Additional information has been requested. 5/2/08 Reviewed hospital medical records of 9/7-9/8/07. FINAL DX: non provided, no d/c summary available. Records reveal patient experienced fever, generalized body aches & achy abdominal pain x 1 day, worse on deep inspiration, better if lying down. Exam revealed tenderness RUQ & RLQ. Admitted for observation. GYN & surgical consults done. D/C to home.


Changed on 9/14/2017

309412 Before After
VAERS Form:(blank) 1
Age:16.0
Gender:Female
Location:Illinois
Vaccinated:2007-09-05
Onset:2007-09-05
Submitted:2008-04-11
Entered:2008-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1060U / 1 2 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Full blood count, Lymphadenitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: ACCUTANE
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: x-ray; computed axial; complete blood cell; urinalysis LABS: UA w/1+ total protein, WBC 6-10, RBC 6-20, occ bacteria, c/s neg. CBC, amylase, lipase, ASO, mono & chemistry WNL. ESR 25 (H)CXR WNL. US of gallbladder WNL. CT of abdomen/pelvis mildly prominent lymph nodes in RLQ & small left ovarian cyst c/w simple mid-cycle ovulation cyst.
CDC 'Split Type': WAES0804USA00372

Write-up:Information has been received from a registered nurse concerning her 16 year old daughter with no known drug allergies and no medical history reported, who on 04-SEP-2007 was vaccinated intramuscularly with the second dose of Gardasil. Concomitant therapy included ACCUTANE. On 05-SEP-2007, the patient developed acute abdominal pain "within 24 hours of the vaccination," and was hospitalized for three days. The patient was diagnosed with mesenteric lymphadenitis and was treated with antibiotics and pain medications. Diagnostic laboratory studies performed, with no results reported, included: complete blood cell count, urine test, x-ray and computed axial tomography. On 09-SEP-2007 the patient recovered and was released from the hospital. No product quality complaint was involved. Mesenteric lymphadenitis was considered to be disabling and an other important medical event. Additional information has been requested. 5/2/08 Reviewed hospital medical records of 9/7-9/8/07. FINAL DX: non provided, no d/c summary available. Records reveal patient experienced fever, generalized body aches & achy abdominal pain x 1 day, worse on deep inspiration, better if lying down. Exam revealed tenderness RUQ & RLQ. Admitted for observation. GYN & surgical consults done. D/C to home.


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