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This is VAERS ID 328753

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

VAERS ID: 328753
Age:12.0
Gender:Female
Location:Florida
Vaccinated:2008-01-04
Onset:2008-02-12
Submitted:2008-10-16
Entered:2008-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AFWB218BA / 0 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1267U / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2545AA / 0 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2544204 / 0 RA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Abdominal pain upper, Aggression, Activities of daily living impaired

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 64     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: 3 endoscopies w/ biopsy, abdominal CT and ultrasound. Various Lab tests: CBC,Heavy Metals Comp. Panel, Hummoral immunity Eval., Celiac Disease Comp Panel, CMP, Anti- Streptolysin. EEG( with abnormal findings),MRI of the Brain(normal). Stool
CDC 'Split Type':

Write-up:Chronic stomach pain onset after 5 weeks, Diagnosis of Gastritis after 7 weeks. Increased agitation,irritability, nervousness, distractability. Diagnosis of Bipolar Disorder, General Anxiety Disorder, Oppositional Defiance Disorder after 4 months. Patient"has had 3 endoscopies, 2 ultrasounds and an abdominal CT scan. Patient continues (after 11 months) to complain of chronic abdominla pain. Patient has been treated with various acid blocking medicines. Patient has been Baker Acted to a locked facility 5 ti


Changed on 12/8/2009

VAERS ID: 328753 Before After
Age:12.0
Gender:Female
Location:Florida
Vaccinated:2008-01-04
Onset:2008-02-12
Submitted:2008-10-16
Entered:2008-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AFWB218BA / 0 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1267U / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2545AA / 0 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2544204 / 0 RA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Abdominal pain upper, Aggression, Agitation, Biopsy, Blood creatinine decreased, Blood immunoglobulin A decreased, Blood immunoglobulin G decreased, Blood immunoglobulin M decreased, Computerised tomogram normal, Constipation, Cough, Depression, Distractibility, Dysphonia, Electroencephalogram abnormal, Full blood count normal, Gastritis, Gastrooesophageal reflux disease, Generalised anxiety disorder, Haemangioma of liver, Irritability, Nervousness, Nuclear magnetic resonance imaging brain normal, Pharyngitis, Psychotic behaviour, Ultrasound liver abnormal, Weight decreased, Red blood cell sedimentation rate increased, Activities of daily living impaired, Upper respiratory tract congestion, Oesophagogastroduodenoscopy, Psychiatric evaluation, Oppositional defiant disorder, Bipolar disorder, Stool analysis, Blood heavy metal test, Metabolic function test, Self injurious behaviour, Streptococcus identification test negative, Oropharyngeal pain

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 64     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: 3 endoscopies w/ biopsy, abdominal CT and ultrasound. Various Lab tests: CBC,Heavy Metals Comp. Panel, Hummoral immunity Eval., Celiac Disease Comp Panel, CMP, Anti- Streptolysin. EEG( with abnormal findings),MRI of the Brain(normal). Stool
CDC 'Split Type':

Write-up:Chronic stomach pain onset after 5 weeks, Diagnosis of Gastritis after 7 weeks. Increased agitation,irritability, nervousness, distractability. Diagnosis of Bipolar Disorder, General Anxiety Disorder, Oppositional Defiance Disorder after 4 months. Patient"has Patient has had 3 endoscopies, 2 ultrasounds and an abdominal CT scan. Patient continues (after 11 months) to complain of chronic abdominla pain. Patient has been treated with various acid blocking medicines. Patient has been Baker Acted to a locked facility 5 ti times and once voluntarily in the past 5 months due to psychotic, self- injurious, violent behavior. Patient was admitted to a Behavioral Residnetial treatment center for 8 weeks. Patient has been on various anti-depressants, anti-psychotic and mood stabilizers. Patient is at present still under psychiatric, psychological and gastrointestinal care. Prior to vaccinations, 12 year old patient showed no evidence of either gastrointestinal condition or mental illness. 11/4/08 Reviewed PCP medical records of 1/4-9/16/08. FINAL DX: none provided Records reveal patient experienced general good health on 1/4/08. RTC 2/6/08 w/cough, congestion, hoarseness & sore throat. Dx w/pharyngitis. RTC 2/15 w/abdominal pain, cough, constipation. RTC 2/22, had missed 2 wks of school w/persistent abdominal pain, 6 # weight loss. Admitted to hosp for peds GI consult. Dx w/gastritis & GERD. Tx w/meds. RTC 9/16/08 s/p admit for depression & bipolar disorder.


Changed on 3/2/2010

VAERS ID: 328753 Before After
Age:12.0
Gender:Female
Location:Florida
Vaccinated:2008-01-04
Onset:2008-02-12
Submitted:2008-10-16
Entered:2008-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AFWB218BA / 0 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1267U / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2545AA / 0 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2544204 / 0 RA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Abdominal pain upper, Aggression, Agitation, Biopsy, Blood creatinine decreased, Blood immunoglobulin A decreased, Blood immunoglobulin G decreased, Blood immunoglobulin M decreased, Computerised tomogram normal, Constipation, Cough, Depression, Distractibility, Dysphonia, Electroencephalogram abnormal, Full blood count normal, Gastritis, Gastrooesophageal reflux disease, Generalised anxiety disorder, Haemangioma of liver, Irritability, Nervousness, Nuclear magnetic resonance imaging brain normal, Pharyngitis, Psychotic behaviour, Ultrasound liver abnormal, Weight decreased, Red blood cell sedimentation rate increased, Activities of daily living impaired, Upper respiratory tract congestion, Oesophagogastroduodenoscopy, Psychiatric evaluation, Oppositional defiant disorder, Bipolar disorder, Stool analysis, Blood heavy metal test, Metabolic function test, Self injurious behaviour, Streptococcus identification test negative, Oropharyngeal pain

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 64     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: 3 endoscopies w/ biopsy, abdominal CT and ultrasound. Various Lab tests: CBC,Heavy Metals Comp. Panel, Hummoral immunity Eval., Celiac Disease Comp Panel, CMP, Anti- Streptolysin. EEG( with abnormal findings),MRI of the Brain(normal). Stool
CDC 'Split Type':

Write-up:Chronic stomach pain onset after 5 weeks, Diagnosis of Gastritis after 7 weeks. Increased agitation,irritability, nervousness, distractability. Diagnosis of Bipolar Disorder, General Anxiety Disorder, Oppositional Defiance Disorder after 4 months. Patient has had 3 endoscopies, 2 ultrasounds and an abdominal CT scan. Patient continues (after 11 months) to complain of chronic abdominla pain. Patient has been treated with various acid blocking medicines. Patient has been Baker Acted to a locked facility 5 times and once voluntarily in the past 5 months due to psychotic, self- injurious, violent behavior. Patient was admitted to a Behavioral Residnetial treatment center for 8 weeks. Patient has been on various anti-depressants, anti-psychotic and mood stabilizers. Patient is at present still under psychiatric, psychological and gastrointestinal care. Prior to vaccinations, 12 year old patient showed no evidence of either gastrointestinal condition or mental illness. 11/4/08 Reviewed PCP medical records of 1/4-9/16/08. FINAL DX: none provided Records reveal patient experienced general good health on 1/4/08. RTC 2/6/08 w/cough, congestion, hoarseness & sore throat. Dx w/pharyngitis. RTC 2/15 w/abdominal pain, cough, constipation. RTC 2/22, had missed 2 wks of school w/persistent abdominal pain, 6 # weight loss. Admitted to hosp for peds GI consult. Dx w/gastritis & GERD. Tx w/meds. RTC 9/16/08 s/p admit for depression & bipolar disorder.


Changed on 4/7/2010

VAERS ID: 328753 Before After
Age:12.0
Gender:Female
Location:Florida
Vaccinated:2008-01-04
Onset:2008-02-12
Submitted:2008-10-16
Entered:2008-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AFWB218BA / 0 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1267U / 0 RA / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2545AA / 0 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2544204 / 0 RA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Abdominal pain upper, Aggression, Agitation, Biopsy, Blood creatinine decreased, Blood immunoglobulin A decreased, Blood immunoglobulin G decreased, Blood immunoglobulin M decreased, Computerised tomogram normal, Constipation, Cough, Depression, Distractibility, Dysphonia, Electroencephalogram abnormal, Full blood count normal, Gastritis, Gastrooesophageal reflux disease, Generalised anxiety disorder, Haemangioma of liver, Irritability, Nervousness, Nuclear magnetic resonance imaging brain normal, Pharyngitis, Psychotic behaviour, Ultrasound liver abnormal, Weight decreased, Red blood cell sedimentation rate increased, Activities of daily living impaired, Upper respiratory tract congestion, Oesophagogastroduodenoscopy, Psychiatric evaluation, Oppositional defiant disorder, Bipolar disorder, Stool analysis, Blood heavy metal test, Metabolic function test, Self injurious behaviour, Streptococcus identification test negative, Oropharyngeal pain

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 64     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: 3 endoscopies w/ biopsy, abdominal CT and ultrasound. Various Lab tests: CBC,Heavy Metals Comp. Panel, Hummoral immunity Eval., Celiac Disease Comp Panel, CMP, Anti- Streptolysin. EEG( with abnormal findings),MRI of the Brain(normal). Stool
CDC 'Split Type':

Write-up:Chronic stomach pain onset after 5 weeks, Diagnosis of Gastritis after 7 weeks. Increased agitation,irritability, nervousness, distractability. Diagnosis of Bipolar Disorder, General Anxiety Disorder, Oppositional Defiance Disorder after 4 months. Patient has had 3 endoscopies, 2 ultrasounds and an abdominal CT scan. Patient continues (after 11 months) to complain of chronic abdominla pain. Patient has been treated with various acid blocking medicines. Patient has been Baker Acted to a locked facility 5 times and once voluntarily in the past 5 months due to psychotic, self- injurious, violent behavior. Patient was admitted to a Behavioral Residnetial treatment center for 8 weeks. Patient has been on various anti-depressants, anti-psychotic and mood stabilizers. Patient is at present still under psychiatric, psychological and gastrointestinal care. Prior to vaccinations, 12 year old patient showed no evidence of either gastrointestinal condition or mental illness. 11/4/08 Reviewed PCP medical records of 1/4-9/16/08. FINAL DX: none provided Records reveal patient experienced general good health on 1/4/08. RTC 2/6/08 w/cough, congestion, hoarseness & sore throat. Dx w/pharyngitis. RTC 2/15 w/abdominal pain, cough, constipation. RTC 2/22, had missed 2 wks of school w/persistent abdominal pain, 6 # weight loss. Admitted to hosp for peds GI consult. Dx w/gastritis & GERD. Tx w/meds. RTC 9/16/08 s/p admit for depression & bipolar disorder.


Changed on 1/4/2011

VAERS ID: 328753 Before After
Age:12.0
Gender:Female
Location:Florida
Vaccinated:2008-01-04
Onset:2008-02-12
Submitted:2008-10-16
Entered:2008-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AFWB218BA / 0 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1267U / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2545AA / 0 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2544204 / 0 RA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Abdominal pain upper, Aggression, Agitation, Biopsy, Blood creatinine decreased, Blood immunoglobulin A decreased, Blood immunoglobulin G decreased, Blood immunoglobulin M decreased, Computerised tomogram normal, Constipation, Cough, Depression, Distractibility, Dysphonia, Electroencephalogram abnormal, Full blood count normal, Gastritis, Gastrooesophageal reflux disease, Generalised anxiety disorder, Haemangioma of liver, Irritability, Nervousness, Nuclear magnetic resonance imaging brain normal, Pharyngitis, Psychotic behaviour, Ultrasound liver abnormal, Weight decreased, Red blood cell sedimentation rate increased, Activities of daily living impaired, Upper respiratory tract congestion, Oesophagogastroduodenoscopy, Psychiatric evaluation, Oppositional defiant disorder, Bipolar disorder, Stool analysis, Blood heavy metal test, Metabolic function test, Self injurious behaviour, Streptococcus identification test negative, Oropharyngeal pain

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 64     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: 3 endoscopies w/ biopsy, abdominal CT and ultrasound. Various Lab tests: CBC,Heavy Metals Comp. Panel, Hummoral immunity Eval., Celiac Disease Comp Panel, CMP, Anti- Streptolysin. EEG( with abnormal findings),MRI of the Brain(normal). Stool tests and organic acid tests(pending) Psychiatric evaluations LABS: 2/20/08 hospital labs: Sed rate 29(H), creatinine 0.4(L), Labs 8/08: IgA 46(L), IgG 875(L), IgM 39(L)rapid strep neg. CBC WNL. US of liver/gallblader revealed hemangioma which increased from 10/10/06 to 2/20/08. CT abdomen/pelvis WNL. EGD done 4/9/08 WNL.
CDC 'Split Type':

Write-up:Chronic stomach pain onset after 5 weeks, Diagnosis of Gastritis after 7 weeks. Increased agitation,irritability, nervousness, distractability. Diagnosis of Bipolar Disorder, General Anxiety Disorder, Oppositional Defiance Disorder after 4 months. Patient has had 3 endoscopies, 2 ultrasounds and an abdominal CT scan. Patient continues (after 11 months) to complain of chronic abdominla pain. Patient has been treated with various acid blocking medicines. Patient has been Baker Acted to a locked facility 5 times and once voluntarily in the past 5 months due to psychotic, self- injurious, violent behavior. Patient was admitted to a Behavioral Residnetial treatment center for 8 weeks. Patient has been on various anti-depressants, anti-psychotic and mood stabilizers. Patient is at present still under psychiatric, psychological and gastrointestinal care. Prior to vaccinations, 12 year old patient showed no evidence of either gastrointestinal condition or mental illness. 11/4/08 Reviewed PCP medical records of 1/4-9/16/08. FINAL DX: none provided Records reveal patient experienced general good health on 1/4/08. RTC 2/6/08 w/cough, congestion, hoarseness & sore throat. Dx w/pharyngitis. RTC 2/15 w/abdominal pain, cough, constipation. RTC 2/22, had missed 2 wks of school w/persistent abdominal pain, 6 # weight loss. Admitted to hosp for peds GI consult. Dx w/gastritis & GERD. Tx w/meds. RTC 9/16/08 s/p admit for depression & bipolar disorder.


Changed on 4/13/2011

VAERS ID: 328753 Before After
Age:12.0
Gender:Female
Location:Florida
Vaccinated:2008-01-04
Onset:2008-02-12
Submitted:2008-10-16
Entered:2008-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AFWB218BA / 0 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1267U / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2545AA / 0 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2544204 / 0 RA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Abdominal pain upper, Aggression, Agitation, Biopsy, Blood creatinine decreased, Blood immunoglobulin A decreased, Blood immunoglobulin G decreased, Blood immunoglobulin M decreased, Computerised tomogram normal, Constipation, Cough, Depression, Distractibility, Dysphonia, Electroencephalogram abnormal, Full blood count normal, Gastritis, Gastrooesophageal reflux disease, Generalised anxiety disorder, Haemangioma of liver, Irritability, Nervousness, Nuclear magnetic resonance imaging brain normal, Pharyngitis, Psychotic behaviour, Ultrasound liver abnormal, Weight decreased, Red blood cell sedimentation rate increased, Activities of daily living impaired, Upper respiratory tract congestion, Oesophagogastroduodenoscopy, Psychiatric evaluation, Oppositional defiant disorder, Bipolar disorder, Stool analysis, Blood heavy metal test, Metabolic function test, Self injurious behaviour, Streptococcus identification test negative, Oropharyngeal pain

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 64     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: 3 endoscopies w/ biopsy, abdominal CT and ultrasound. Various Lab tests: CBC,Heavy Metals Comp. Panel, Hummoral immunity Eval., Celiac Disease Comp Panel, CMP, Anti- Streptolysin. EEG( with abnormal findings),MRI of the Brain(normal). Stool tests and organic acid tests(pending) Psychiatric evaluations LABS: 2/20/08 hospital labs: Sed rate 29(H), creatinine 0.4(L), Labs 8/08: IgA 46(L), IgG 875(L), IgM 39(L)rapid strep neg. CBC WNL. US of liver/gallblader revealed hemangioma which increased from 10/10/06 to 2/20/08. CT abdomen/pelvis WNL. EGD done 4/9/08 WNL.
CDC 'Split Type':

Write-up:Chronic stomach pain onset after 5 weeks, Diagnosis of Gastritis after 7 weeks. Increased agitation,irritability, nervousness, distractability. Diagnosis of Bipolar Disorder, General Anxiety Disorder, Oppositional Defiance Disorder after 4 months. Patient has had 3 endoscopies, 2 ultrasounds and an abdominal CT scan. Patient continues (after 11 months) to complain of chronic abdominla pain. Patient has been treated with various acid blocking medicines. Patient has been Baker Acted to a locked facility 5 times and once voluntarily in the past 5 months due to psychotic, self- injurious, violent behavior. Patient was admitted to a Behavioral Residnetial treatment center for 8 weeks. Patient has been on various anti-depressants, anti-psychotic and mood stabilizers. Patient is at present still under psychiatric, psychological and gastrointestinal care. Prior to vaccinations, 12 year old patient showed no evidence of either gastrointestinal condition or mental illness. 11/4/08 Reviewed PCP medical records of 1/4-9/16/08. FINAL DX: none provided Records reveal patient experienced general good health on 1/4/08. RTC 2/6/08 w/cough, congestion, hoarseness & sore throat. Dx w/pharyngitis. RTC 2/15 w/abdominal pain, cough, constipation. RTC 2/22, had missed 2 wks of school w/persistent abdominal pain, 6 # weight loss. Admitted to hosp for peds GI consult. Dx w/gastritis & GERD. Tx w/meds. RTC 9/16/08 s/p admit for depression & bipolar disorder.


Changed on 5/13/2011

VAERS ID: 328753 Before After
Age:12.0
Gender:Female
Location:Florida
Vaccinated:2008-01-04
Onset:2008-02-12
Submitted:2008-10-16
Entered:2008-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AFWB218BA / 0 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1267U / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2545AA / 0 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2544204 / 0 RA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Abdominal pain upper, Aggression, Agitation, Biopsy, Blood creatinine decreased, Blood immunoglobulin A decreased, Blood immunoglobulin G decreased, Blood immunoglobulin M decreased, Computerised tomogram normal, Constipation, Cough, Depression, Distractibility, Dysphonia, Electroencephalogram abnormal, Full blood count normal, Gastritis, Gastrooesophageal reflux disease, Generalised anxiety disorder, Haemangioma of liver, Irritability, Nervousness, Nuclear magnetic resonance imaging brain normal, Pharyngitis, Psychotic behaviour, Ultrasound liver abnormal, Weight decreased, Red blood cell sedimentation rate increased, Activities of daily living impaired, Upper respiratory tract congestion, Oesophagogastroduodenoscopy, Psychiatric evaluation, Oppositional defiant disorder, Bipolar disorder, Stool analysis, Blood heavy metal test, Metabolic function test, Self injurious behaviour, Streptococcus identification test negative, Oropharyngeal pain

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 64     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: 3 endoscopies w/ biopsy, abdominal CT and ultrasound. Various Lab tests: CBC,Heavy Metals Comp. Panel, Hummoral immunity Eval., Celiac Disease Comp Panel, CMP, Anti- Streptolysin. EEG( with abnormal findings),MRI of the Brain(normal). Stool tests and organic acid tests(pending) Psychiatric evaluations LABS: 2/20/08 hospital labs: Sed rate 29(H), creatinine 0.4(L), Labs 8/08: IgA 46(L), IgG 875(L), IgM 39(L)rapid strep neg. CBC WNL. US of liver/gallblader revealed hemangioma which increased from 10/10/06 to 2/20/08. CT abdomen/pelvis WNL. EGD done 4/9/08 WNL.
CDC 'Split Type':

Write-up:Chronic stomach pain onset after 5 weeks, Diagnosis of Gastritis after 7 weeks. Increased agitation,irritability, nervousness, distractability. Diagnosis of Bipolar Disorder, General Anxiety Disorder, Oppositional Defiance Disorder after 4 months. Patient has had 3 endoscopies, 2 ultrasounds and an abdominal CT scan. Patient continues (after 11 months) to complain of chronic abdominla pain. Patient has been treated with various acid blocking medicines. Patient has been Baker Acted to a locked facility 5 times and once voluntarily in the past 5 months due to psychotic, self- injurious, violent behavior. Patient was admitted to a Behavioral Residnetial treatment center for 8 weeks. Patient has been on various anti-depressants, anti-psychotic and mood stabilizers. Patient is at present still under psychiatric, psychological and gastrointestinal care. Prior to vaccinations, 12 year old patient showed no evidence of either gastrointestinal condition or mental illness. 11/4/08 Reviewed PCP medical records of 1/4-9/16/08. FINAL DX: none provided Records reveal patient experienced general good health on 1/4/08. RTC 2/6/08 w/cough, congestion, hoarseness & sore throat. Dx w/pharyngitis. RTC 2/15 w/abdominal pain, cough, constipation. RTC 2/22, had missed 2 wks of school w/persistent abdominal pain, 6 # weight loss. Admitted to hosp for peds GI consult. Dx w/gastritis & GERD. Tx w/meds. RTC 9/16/08 s/p admit for depression & bipolar disorder.


Changed on 6/11/2011

VAERS ID: 328753 Before After
Age:12.0
Gender:Female
Location:Florida
Vaccinated:2008-01-04
Onset:2008-02-12
Submitted:2008-10-16
Entered:2008-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AFWB218BA / 0 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1267U / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2545AA / 0 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2544204 / 0 RA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Abdominal pain upper, Aggression, Agitation, Biopsy, Blood creatinine decreased, Blood immunoglobulin A decreased, Blood immunoglobulin G decreased, Blood immunoglobulin M decreased, Computerised tomogram normal, Constipation, Cough, Depression, Distractibility, Dysphonia, Electroencephalogram abnormal, Full blood count normal, Gastritis, Gastrooesophageal reflux disease, Generalised anxiety disorder, Haemangioma of liver, Irritability, Nervousness, Nuclear magnetic resonance imaging brain normal, Pharyngitis, Psychotic behaviour, Ultrasound liver abnormal, Weight decreased, Red blood cell sedimentation rate increased, Activities of daily living impaired, Upper respiratory tract congestion, Oesophagogastroduodenoscopy, Psychiatric evaluation, Oppositional defiant disorder, Bipolar disorder, Stool analysis, Blood heavy metal test, Metabolic function test, Self injurious behaviour, Streptococcus identification test negative, Oropharyngeal pain

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 64     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: 3 endoscopies w/ biopsy, abdominal CT and ultrasound. Various Lab tests: CBC,Heavy Metals Comp. Panel, Hummoral immunity Eval., Celiac Disease Comp Panel, CMP, Anti- Streptolysin. EEG( with abnormal findings),MRI of the Brain(normal). Stool tests and organic acid tests(pending) Psychiatric evaluations LABS: 2/20/08 hospital labs: Sed rate 29(H), creatinine 0.4(L), Labs 8/08: IgA 46(L), IgG 875(L), IgM 39(L)rapid strep neg. CBC WNL. US of liver/gallblader revealed hemangioma which increased from 10/10/06 to 2/20/08. CT abdomen/pelvis WNL. EGD done 4/9/08 WNL.
CDC 'Split Type':

Write-up:Chronic stomach pain onset after 5 weeks, Diagnosis of Gastritis after 7 weeks. Increased agitation,irritability, nervousness, distractability. Diagnosis of Bipolar Disorder, General Anxiety Disorder, Oppositional Defiance Disorder after 4 months. Patient has had 3 endoscopies, 2 ultrasounds and an abdominal CT scan. Patient continues (after 11 months) to complain of chronic abdominla pain. Patient has been treated with various acid blocking medicines. Patient has been Baker Acted to a locked facility 5 times and once voluntarily in the past 5 months due to psychotic, self- injurious, violent behavior. Patient was admitted to a Behavioral Residnetial treatment center for 8 weeks. Patient has been on various anti-depressants, anti-psychotic and mood stabilizers. Patient is at present still under psychiatric, psychological and gastrointestinal care. Prior to vaccinations, 12 year old patient showed no evidence of either gastrointestinal condition or mental illness. 11/4/08 Reviewed PCP medical records of 1/4-9/16/08. FINAL DX: none provided Records reveal patient experienced general good health on 1/4/08. RTC 2/6/08 w/cough, congestion, hoarseness & sore throat. Dx w/pharyngitis. RTC 2/15 w/abdominal pain, cough, constipation. RTC 2/22, had missed 2 wks of school w/persistent abdominal pain, 6 # weight loss. Admitted to hosp for peds GI consult. Dx w/gastritis & GERD. Tx w/meds. RTC 9/16/08 s/p admit for depression & bipolar disorder.


Changed on 4/14/2017

VAERS ID: 328753 Before After
Age:12.0
Gender:Female
Location:Florida
Vaccinated:2008-01-04
Onset:2008-02-12
Submitted:2008-10-16
Entered:2008-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AFWB218BA / 0 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1267U / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2545AA / 0 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2544204 / 0 RA / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Abdominal pain, Abdominal pain upper, Aggression, Agitation, Biopsy, Blood creatinine decreased, Blood immunoglobulin A decreased, Blood immunoglobulin G decreased, Blood immunoglobulin M decreased, Computerised tomogram normal, Constipation, Cough, Depression, Distractibility, Dysphonia, Electroencephalogram abnormal, Full blood count normal, Gastritis, Gastrooesophageal reflux disease, Generalised anxiety disorder, Haemangioma of liver, Irritability, Nervousness, Nuclear magnetic resonance imaging brain normal, Pharyngitis, Psychotic behaviour, Ultrasound liver abnormal, Weight decreased, Red blood cell sedimentation rate increased, Activities of daily living impaired, Upper respiratory tract congestion, Oesophagogastroduodenoscopy, Psychiatric evaluation, Oppositional defiant disorder, Bipolar disorder, Stool analysis, Blood heavy metal test, Metabolic function test, Self injurious behaviour, Streptococcus identification test negative, Oropharyngeal pain

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 64     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: 3 endoscopies w/ biopsy, abdominal CT and ultrasound. Various Lab tests: CBC,Heavy Metals Comp. Panel, Hummoral immunity Eval., Celiac Disease Comp Panel, CMP, Anti- Streptolysin. EEG( with abnormal findings),MRI of the Brain(normal). Stool tests and organic acid tests(pending) Psychiatric evaluations LABS: 2/20/08 hospital labs: Sed rate 29(H), creatinine 0.4(L), Labs 8/08: IgA 46(L), IgG 875(L), IgM 39(L)rapid strep neg. CBC WNL. US of liver/gallblader revealed hemangioma which increased from 10/10/06 to 2/20/08. CT abdomen/pelvis WNL. EGD done 4/9/08 WNL.
CDC 'Split Type':

Write-up:Chronic stomach pain onset after 5 weeks, Diagnosis of Gastritis after 7 weeks. Increased agitation,irritability, nervousness, distractability. Diagnosis of Bipolar Disorder, General Anxiety Disorder, Oppositional Defiance Disorder after 4 months. Patient has had 3 endoscopies, 2 ultrasounds and an abdominal CT scan. Patient continues (after 11 months) to complain of chronic abdominla pain. Patient has been treated with various acid blocking medicines. Patient has been Baker Acted to a locked facility 5 times and once voluntarily in the past 5 months due to psychotic, self- injurious, violent behavior. Patient was admitted to a Behavioral Residnetial treatment center for 8 weeks. Patient has been on various anti-depressants, anti-psychotic and mood stabilizers. Patient is at present still under psychiatric, psychological and gastrointestinal care. Prior to vaccinations, 12 year old patient showed no evidence of either gastrointestinal condition or mental illness. 11/4/08 Reviewed PCP medical records of 1/4-9/16/08. FINAL DX: none provided Records reveal patient experienced general good health on 1/4/08. RTC 2/6/08 w/cough, congestion, hoarseness & sore throat. Dx w/pharyngitis. RTC 2/15 w/abdominal pain, cough, constipation. RTC 2/22, had missed 2 wks of school w/persistent abdominal pain, 6 # weight loss. Admitted to hosp for peds GI consult. Dx w/gastritis & GERD. Tx w/meds. RTC 9/16/08 s/p admit for depression & bipolar disorder.


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