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This is VAERS ID 336652

History of Changes from the VAERS Wayback Machine

First Appeared on 12/31/2008

336652
VAERS Form:
Age:16.0
Gender:Female
Location:Pennsylvania
Vaccinated:2008-08-26
Onset:2008-10-01
Submitted:2008-12-12
Entered:2008-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0070X / 1 LA / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Anorexia, Antinuclear antibody negative, Chills, Computerised tomogram normal, Borrelia burgdorferi serology

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: None
Current Illness:
Preexisting Conditions: None PMH: multiple nevi
Allergies:
Diagnostic Lab Data: Unknown LABS: CT & MRI/MRV brain WNL. ESR, CBC, ANA & RA factor WNL.
CDC 'Split Type':

Write-up:Information has been received from a consumer concerning her 17 year old daughter with no relevant medical history or allergies who on approximately 23-JUN-2008, was vaccinated with a first dose of GARDASIL (lot number, injection site and route not report"ed). The patient did not have adverse reaction after receiving the first dose. On 25-AUG-2008 the patient was vaccinated with a second dose of GARDASIL (lot number, injection site and route not reported). There was no concomitant medication. In the fi


Changed on 12/8/2009

336652 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Pennsylvania
Vaccinated:2008-08-26
Onset:2008-10-01
Submitted:2008-12-12
Entered:2008-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0070X / 1 LA / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Anorexia, Antinuclear antibody negative, Chills, Computerised tomogram normal, Dizziness, Feeling hot, Full blood count normal, Headache, Influenza like illness, Joint swelling, Lymph node pain, Neck pain, Nuclear magnetic resonance imaging brain normal, Pain, Photophobia, Stomach discomfort, Viral infection, Rheumatoid factor negative, Red blood cell sedimentation rate normal, Borrelia burgdorferi serology

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: None
Current Illness:
Preexisting Conditions: None PMH: multiple nevi
Allergies:
Diagnostic Lab Data: Unknown LABS: CT & MRI/MRV brain WNL. ESR, CBC, ANA & RA factor WNL.
CDC 'Split Type': (blank) WAES0811USA02286

Write-up:Information has been received from a consumer concerning her 17 year old daughter with no relevant medical history or allergies who on approximately 23-JUN-2008, was vaccinated with a first dose of GARDASIL (lot number, injection site and route not report"ed). reported). The patient did not have adverse reaction after receiving the first dose. On 25-AUG-2008 the patient was vaccinated with a second dose of GARDASIL (lot number, injection site and route not reported). There was no concomitant medication. In the fi first week of October 2008, the patient experienced constant headache, loss of appetite, flu like symptoms and joint swelling. Unspecified medical attention was sought. Laboratory test included MRI cat scan, lime test and rheumatoid test (result unspecified). On 14-NOV-2008 the patient complained that her stomach is bothering her. The patient''s events persisted. Additional information has been requested. 1/12/2009 Reviewed PCP medical records of 6/25/08-1/8/2009. FINAL DX: pain amplification syndrome Records reveal patient experienced intermittent throbbing frontal HA, photophobia & dizziness x 1 mo when seen 10/31/08. RTC 11/5 w/continued HA, chills, hot feeling & sore neck. Exam revealed tender supraventricular nodule. Dx w/viral illness. Neuro consult done 11/6/08. Tx w/steroid taper. Developed joint swelling Rheumatology consult done 12/1/08 & dx w/pain amplification syndrome.


Changed on 3/2/2010

336652 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Pennsylvania
Vaccinated:2008-08-26
Onset:2008-10-01
Submitted:2008-12-12
Entered:2008-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0070X / 1 LA / IM

Administered by: Other Private      Purchased by: Other
Symptoms: Anorexia, Antinuclear antibody negative, Chills, Computerised tomogram normal, Dizziness, Feeling hot, Full blood count normal, Headache, Influenza like illness, Joint swelling, Lymph node pain, Neck pain, Nuclear magnetic resonance imaging brain normal, Pain, Photophobia, Stomach discomfort, Viral infection, Rheumatoid factor negative, Red blood cell sedimentation rate normal, Borrelia burgdorferi serology

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No 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: None
Current Illness:
Preexisting Conditions: None PMH: multiple nevi nevi; Epistaxis
Allergies:
Diagnostic Lab Data: Unknown LABS: CT & MRI/MRV brain WNL. ESR, CBC, ANA & RA factor WNL. head computed axial, 11/04/08, normal; magnetic resonance, Head normal; renal function study, 11/10/08, normal; diagnostic laboratory, 70, C3D immune complex; Lyme di
CDC 'Split Type': WAES0811USA02286

Write-up:Information has been received from a consumer concerning her 17 year old daughter with no relevant medical history or allergies who on approximately 23-JUN-2008, was vaccinated with a first dose of GARDASIL (lot number, injection site and route not reported). The patient did not have adverse reaction after receiving the first dose. On 25-AUG-2008 the patient was vaccinated with a second dose of GARDASIL (lot number, injection site and route not reported). There was no concomitant medication. In the first week of October 2008, the patient experienced constant headache, loss of appetite, flu like symptoms and joint swelling. Unspecified medical attention was sought. Laboratory test included MRI cat scan, lime test and rheumatoid test (result unspecified). On 14-NOV-2008 the patient complained that her stomach is bothering her. The patient''s events persisted. Additional information has been requested. 1/12/2009 Reviewed PCP medical records of 6/25/08-1/8/2009. FINAL DX: pain amplification syndrome Records reveal patient experienced intermittent throbbing frontal HA, photophobia & dizziness x 1 mo when seen 10/31/08. RTC 11/5 w/continued HA, chills, hot feeling & sore neck. Exam revealed tender supraventricular nodule. Dx w/viral illness. Neuro consult done 11/6/08. Tx w/steroid taper. Developed joint swelling Rheumatology consult done 12/1/08 & dx w/pain amplification syndrome. This is in follow-up to report(s) previously submitted on 12/12/2008. Follow-up information was received on 15-DEC-2008 from a registered nurse who reported that the female patient was vaccinated with the second dose of GARDASIL (lot number 660553/0070X) in the left deltoid on 26-AUG-2008. In October 2008, the patient experienced headaches for 2 months, chills, sore neck and joint swelling. The patient was referred to see neurologist and rheumatologist. On 06-NOV-2008, the patient was seen by a neurologist. According to the medical record, the patient had no significant past medical history except for frequent nosebleed


Changed on 4/7/2010

336652 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Pennsylvania
Vaccinated:2008-08-26
Onset:2008-10-01
Submitted:2008-12-12
Entered:2008-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0070X / 1 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Abdominal discomfort, Abdominal pain, Anorexia, Antinuclear antibody negative, Arthralgia, Asthenia, Blood immunoglobulin E normal, Blood immunoglobulin G normal, Blood immunoglobulin M normal, Chills, Computerised tomogram normal, Eye pain, Fatigue, Full blood count normal, Headache, Immunoglobulins normal, Influenza like illness, Joint swelling, Musculoskeletal pain, Nausea, Neck pain, Nuclear magnetic resonance imaging brain normal, Nuclear magnetic resonance imaging normal, Photophobia, Sleep disorder, Thyroid function test normal, Venogram, Rheumatoid factor negative, Red blood cell sedimentation rate decreased, Complement factor C4, No reaction on previous exposure to drug, Liver function test normal, Feeling of body temperature change, Renal function test normal, Scan brain, C1 esterase inhibitor test, Epstein-Barr virus test negative, Borrelia test negative, Parvovirus B19 test negative

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: None
Current Illness:
Preexisting Conditions: None PMH: multiple nevi; Epistaxis
Allergies:
Diagnostic Lab Data: Unknown LABS: CT & MRI/MRV brain WNL. ESR, CBC, ANA & RA factor WNL. head computed axial, 11/04/08, normal; magnetic resonance, Head normal; renal function study, 11/10/08, normal; diagnostic laboratory, 70, C3D immune complex; Lyme di
CDC 'Split Type': WAES0811USA02286

Write-up:Information has been received from a consumer concerning her 17 year old daughter with no relevant medical history or allergies who on approximately 23-JUN-2008, was vaccinated with a first dose of GARDASIL (lot number, injection site and route not reported). The patient did not have adverse reaction after receiving the first dose. On 25-AUG-2008 the patient was vaccinated with a second dose of GARDASIL (lot number, injection site and route not reported). There was no concomitant medication. In the first week of October 2008, the patient experienced constant headache, loss of appetite, flu like symptoms and joint swelling. Unspecified medical attention was sought. Laboratory test included MRI cat scan, lime test and rheumatoid test (result unspecified). On 14-NOV-2008 the patient complained that her stomach is bothering her. The patient''s events persisted. Additional information has been requested. 1/12/2009 Reviewed PCP medical records of 6/25/08-1/8/2009. FINAL DX: pain amplification syndrome Records reveal patient experienced intermittent throbbing frontal HA, photophobia & dizziness x 1 mo when seen 10/31/08. RTC 11/5 w/continued HA, chills, hot feeling & sore neck. Exam revealed tender supraventricular nodule. Dx w/viral illness. Neuro consult done 11/6/08. Tx w/steroid taper. Developed joint swelling Rheumatology consult done 12/1/08 & dx w/pain amplification syndrome. This is in follow-up to report(s) previously submitted on 12/12/2008. Follow-up information was received on 15-DEC-2008 from a registered nurse who reported that the female patient was vaccinated with the second dose of GARDASIL (lot number 660553/0070X) in the left deltoid on 26-AUG-2008. In October 2008, the patient experienced headaches for 2 months, chills, sore neck and joint swelling. The patient was referred to see neurologist and rheumatologist. On 06-NOV-2008, the patient was seen by a neurologist. According to the medical record, the patient had no significant past medical history except for frequent nosebleed


Changed on 7/31/2010

336652 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Pennsylvania
Vaccinated:2008-08-26
Onset:2008-10-01
Submitted:2008-12-12
Entered:2008-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0070X / 1 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Abdominal discomfort, Abdominal pain, Anorexia, Antinuclear antibody negative, Arthralgia, Asthenia, Blood immunoglobulin E normal, Blood immunoglobulin G normal, Blood immunoglobulin M normal, Chills, Computerised tomogram normal, Eye pain, Fatigue, Full blood count normal, Headache, Immunoglobulins normal, Influenza like illness, Joint swelling, Musculoskeletal pain, Nausea, Neck pain, Nuclear magnetic resonance imaging brain normal, Nuclear magnetic resonance imaging normal, Photophobia, Sleep disorder, Thyroid function test normal, Venogram, Rheumatoid factor negative, Red blood cell sedimentation rate decreased, Complement factor C4, No reaction on previous exposure to drug, Liver function test normal, Feeling of body temperature change, Renal function test normal, Scan brain, C1 esterase inhibitor test, Epstein-Barr virus test negative, Borrelia test negative, Parvovirus B19 test negative

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: None
Current Illness:
Preexisting Conditions: None PMH: multiple nevi; Epistaxis
Allergies:
Diagnostic Lab Data: Unknown LABS: CT & MRI/MRV brain WNL. ESR, CBC, ANA & RA factor WNL. head computed axial, 11/04/08, normal; magnetic resonance, Head normal; renal function study, 11/10/08, normal; diagnostic laboratory, 70, C3D immune complex; Lyme di
CDC 'Split Type': WAES0811USA02286

Write-up:Information has been received from a consumer concerning her 17 year old daughter with no relevant medical history or allergies who on approximately 23-JUN-2008, was vaccinated with a first dose of GARDASIL (lot number, injection site and route not reported). The patient did not have adverse reaction after receiving the first dose. On 25-AUG-2008 the patient was vaccinated with a second dose of GARDASIL (lot number, injection site and route not reported). There was no concomitant medication. In the first week of October 2008, the patient experienced constant headache, loss of appetite, flu like symptoms and joint swelling. Unspecified medical attention was sought. Laboratory test included MRI cat scan, lime test and rheumatoid test (result unspecified). On 14-NOV-2008 the patient complained that her stomach is bothering her. The patient''s events persisted. Additional information has been requested. 1/12/2009 Reviewed PCP medical records of 6/25/08-1/8/2009. FINAL DX: pain amplification syndrome Records reveal patient experienced intermittent throbbing frontal HA, photophobia & dizziness x 1 mo when seen 10/31/08. RTC 11/5 w/continued HA, chills, hot feeling & sore neck. Exam revealed tender supraventricular nodule. Dx w/viral illness. Neuro consult done 11/6/08. Tx w/steroid taper. Developed joint swelling Rheumatology consult done 12/1/08 & dx w/pain amplification syndrome. This is in follow-up to report(s) previously submitted on 12/12/2008. Follow-up information was received on 15-DEC-2008 from a registered nurse who reported that the female patient was vaccinated with the second dose of GARDASIL (lot number 660553/0070X) in the left deltoid on 26-AUG-2008. In October 2008, the patient experienced headaches for 2 months, chills, sore neck and joint swelling. The patient was referred to see neurologist and rheumatologist. On 06-NOV-2008, the patient was seen by a neurologist. According to the medical record, the patient had no significant past medical history except for frequent nosebleed


Changed on 8/31/2010

336652 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Pennsylvania
Vaccinated:2008-08-26
Onset:2008-10-01
Submitted:2008-12-12
Entered:2008-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0070X / 1 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Abdominal discomfort, Abdominal pain, Anorexia, Arthralgia, Asthenia, Blood immunoglobulin E normal, Blood immunoglobulin G normal, Blood immunoglobulin M normal, Eye pain, Fatigue, Full blood count normal, Headache, Immunoglobulins normal, Influenza like illness, Joint swelling, Musculoskeletal pain, Nausea, Neck pain, Nuclear magnetic resonance imaging normal, Sleep disorder, Stomach discomfort, Thyroid function test normal, Venogram, Red blood cell sedimentation rate decreased, Complement factor C4, No reaction on previous exposure to drug, Borrelia burgdorferi serology negative, Liver function test normal, Parvovirus B19 serology negative, Decreased appetite, Feeling of body temperature change, Renal function test normal, Scan brain, C1 esterase inhibitor test, Epstein-Barr virus test negative, Borrelia test negative, Parvovirus B19 test negative

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: None
Current Illness:
Preexisting Conditions: None PMH: multiple nevi; Epistaxis
Allergies:
Diagnostic Lab Data: Unknown LABS: CT & MRI/MRV brain WNL. ESR, CBC, ANA & RA factor WNL. head computed axial, 11/04/08, normal; magnetic resonance, Head normal; renal function study, 11/10/08, normal; diagnostic laboratory, 70, C3D immune complex; Lyme di
CDC 'Split Type': WAES0811USA02286

Write-up:Information has been received from a consumer concerning her 17 year old daughter with no relevant medical history or allergies who on approximately 23-JUN-2008, was vaccinated with a first dose of GARDASIL (lot number, injection site and route not reported). The patient did not have adverse reaction after receiving the first dose. On 25-AUG-2008 the patient was vaccinated with a second dose of GARDASIL (lot number, injection site and route not reported). There was no concomitant medication. In the first week of October 2008, the patient experienced constant headache, loss of appetite, flu like symptoms and joint swelling. Unspecified medical attention was sought. Laboratory test included MRI cat scan, lime test and rheumatoid test (result unspecified). On 14-NOV-2008 the patient complained that her stomach is bothering her. The patient''s events persisted. Additional information has been requested. 1/12/2009 Reviewed PCP medical records of 6/25/08-1/8/2009. FINAL DX: pain amplification syndrome Records reveal patient experienced intermittent throbbing frontal HA, photophobia & dizziness x 1 mo when seen 10/31/08. RTC 11/5 w/continued HA, chills, hot feeling & sore neck. Exam revealed tender supraventricular nodule. Dx w/viral illness. Neuro consult done 11/6/08. Tx w/steroid taper. Developed joint swelling Rheumatology consult done 12/1/08 & dx w/pain amplification syndrome. This is in follow-up to report(s) previously submitted on 12/12/2008. Follow-up information was received on 15-DEC-2008 from a registered nurse who reported that the female patient was vaccinated with the second dose of GARDASIL (lot number 660553/0070X) in the left deltoid on 26-AUG-2008. In October 2008, the patient experienced headaches for 2 months, chills, sore neck and joint swelling. The patient was referred to see neurologist and rheumatologist. On 06-NOV-2008, the patient was seen by a neurologist. According to the medical record, the patient had no significant past medical history except for frequent nosebleed


Changed on 1/4/2011

336652 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Pennsylvania
Vaccinated:2008-08-26
Onset:2008-10-01
Submitted:2008-12-12
Entered:2008-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0070X / 1 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Abdominal discomfort, Abdominal pain, Anorexia, Arthralgia, Asthenia, Blood immunoglobulin E normal, Blood immunoglobulin G normal, Blood immunoglobulin M normal, Eye pain, Fatigue, Full blood count normal, Headache, Immunoglobulins normal, Influenza like illness, Joint swelling, Musculoskeletal pain, Nausea, Neck pain, Nuclear magnetic resonance imaging normal, Sleep disorder, Stomach discomfort, Thyroid function test normal, Venogram, Red blood cell sedimentation rate decreased, Complement factor C4, No reaction on previous exposure to drug, Borrelia burgdorferi serology negative, Liver function test normal, Parvovirus B19 serology negative, Decreased appetite, Feeling of body temperature change, Renal function test normal, Scan brain, C1 esterase inhibitor test, Epstein-Barr virus test negative, Borrelia test negative, Parvovirus B19 test negative

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: None
Current Illness:
Preexisting Conditions: None PMH: multiple nevi; Epistaxis
Allergies:
Diagnostic Lab Data: Unknown LABS: CT & MRI/MRV brain WNL. ESR, CBC, ANA & RA factor WNL. head computed axial, 11/04/08, normal; magnetic resonance, Head normal; renal function study, 11/10/08, normal; diagnostic laboratory, 70, C3D immune complex; Lyme di disease assay, negative; Epstein-Barr virus, negative; serum immunoglobulin E, normal; body temp, normal; complete blood cell, 11/10/08, normal; serum rheumatoid factor, 11/10/08, negative; serum ANA, 11/10/08, negative; erythrocyte, 11/10/08, 2, negative; hepatic function tests, 11/10/08, normal; thyroid function test, normal; serum immunoglobin G, negative; serum B39 virus IgM, negative; component C3 test, normal; component C4 test, normal
CDC 'Split Type': WAES0811USA02286

Write-up:Information has been received from a consumer concerning her 17 year old daughter with no relevant medical history or allergies who on approximately 23-JUN-2008, was vaccinated with a first dose of GARDASIL (lot number, injection site and route not reported). The patient did not have adverse reaction after receiving the first dose. On 25-AUG-2008 the patient was vaccinated with a second dose of GARDASIL (lot number, injection site and route not reported). There was no concomitant medication. In the first week of October 2008, the patient experienced constant headache, loss of appetite, flu like symptoms and joint swelling. Unspecified medical attention was sought. Laboratory test included MRI cat scan, lime test and rheumatoid test (result unspecified). On 14-NOV-2008 the patient complained that her stomach is bothering her. The patient''s events persisted. Additional information has been requested. 1/12/2009 Reviewed PCP medical records of 6/25/08-1/8/2009. FINAL DX: pain amplification syndrome Records reveal patient experienced intermittent throbbing frontal HA, photophobia & dizziness x 1 mo when seen 10/31/08. RTC 11/5 w/continued HA, chills, hot feeling & sore neck. Exam revealed tender supraventricular nodule. Dx w/viral illness. Neuro consult done 11/6/08. Tx w/steroid taper. Developed joint swelling Rheumatology consult done 12/1/08 & dx w/pain amplification syndrome. This is in follow-up to report(s) previously submitted on 12/12/2008. Follow-up information was received on 15-DEC-2008 from a registered nurse who reported that the female patient was vaccinated with the second dose of GARDASIL (lot number 660553/0070X) in the left deltoid on 26-AUG-2008. In October 2008, the patient experienced headaches for 2 months, chills, sore neck and joint swelling. The patient was referred to see neurologist and rheumatologist. On 06-NOV-2008, the patient was seen by a neurologist. According to the medical record, the patient had no significant past medical history except for frequent nosebleed nosebleeds and no prior history of headaches. The patient described the headaches as throbbing and predominantly retroorbital in location. The patient also described photophobia and intermittent nausea with no vomiting. The patient did feel somewhat fatigue and felt generally weak. The neurologist asked the patient undergo a MRI scan of the brain to rule out structural cause for her headache as well as an MRV to exclude the possibility of venous sinus thrombus. The neurologist also requested that the patient had a Lyme titer and an erythrocyte sedimentation rate. The neurologist recommended that the patient began a steroid taper taking 40 mg of prednisone daily for two days and then gradually decreasing over the next six days. The neurologist also gave a prescription for TYLENOL No. 3 to use for the patient''s pain. On 01-DEC-2008, the patient was seen by a rheumatologist. According to the medical record, the patient developed pain in both elbows and both knees. The patient did not have morning stiffness. The patient did not have swelling or redness around her joints. The patient found that she slept sore. The patient did not have a fever but felt like she had a tactile temperature and temperature was always normal. The patient also had postprandial abdominal pain? no nausea, vomiting or diarrhea. The laboratory tests showed that CT and MRI of the brain were normal. Her Lyme titer was negative. Her EBV panel was negative as well as parvovirus panel. She had normal complements including C3 and C4. However, one test, which is C3D immune complex that is 70, which is significantly elevated with the upper limits of normal of 8. The rest of immunoglobulins were negative, IgE was normal and thyroid function test was normal as well. Blood work done on 11-10-2008, it was indicative of normal liver and renal panel. The patient had a sed rate of 2, absolutely normal CBC, ANA was negative, rheumatoid factor negative. The patient was treated


Changed on 4/13/2011

336652 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Pennsylvania
Vaccinated:2008-08-26
Onset:2008-10-01
Submitted:2008-12-12
Entered:2008-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0070X / 1 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Abdominal discomfort, Abdominal pain, Anorexia, Antinuclear antibody negative, Arthralgia, Asthenia, Blood immunoglobulin E normal, Blood immunoglobulin G normal, Blood immunoglobulin M normal, Chills, Computerised tomogram normal, Eye pain, Fatigue, Full blood count normal, Headache, Immunoglobulins normal, Influenza like illness, Joint swelling, Musculoskeletal pain, Nausea, Neck pain, Nuclear magnetic resonance imaging brain normal, Nuclear magnetic resonance imaging normal, Photophobia, Sleep disorder, Thyroid function test normal, Venogram, Rheumatoid factor negative, Red blood cell sedimentation rate decreased, Complement factor C4, No reaction on previous exposure to drug, Liver function test normal, Feeling of body temperature change, Renal function test normal, Scan brain, C1 esterase inhibitor test, Epstein-Barr virus test negative, Borrelia test negative, Parvovirus B19 test negative

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: None
Current Illness:
Preexisting Conditions: None PMH: multiple nevi; Epistaxis
Allergies:
Diagnostic Lab Data: Unknown LABS: CT & MRI/MRV brain WNL. ESR, CBC, ANA & RA factor WNL. head computed axial, 11/04/08, normal; magnetic resonance, Head normal; renal function study, 11/10/08, normal; diagnostic laboratory, 70, C3D immune complex; Lyme disease assay, negative; Epstein-Barr virus, negative; serum immunoglobulin E, normal; body temp, normal; complete blood cell, 11/10/08, normal; serum rheumatoid factor, 11/10/08, negative; serum ANA, 11/10/08, negative; erythrocyte, 11/10/08, 2, negative; hepatic function tests, 11/10/08, normal; thyroid function test, normal; serum immunoglobin G, negative; serum B39 virus IgM, negative; component C3 test, normal; component C4 test, normal
CDC 'Split Type': WAES0811USA02286

Write-up:Information has been received from a consumer concerning her 17 year old daughter with no relevant medical history or allergies who on approximately 23-JUN-2008, was vaccinated with a first dose of GARDASIL (lot number, injection site and route not reported). The patient did not have adverse reaction after receiving the first dose. On 25-AUG-2008 the patient was vaccinated with a second dose of GARDASIL (lot number, injection site and route not reported). There was no concomitant medication. In the first week of October 2008, the patient experienced constant headache, loss of appetite, flu like symptoms and joint swelling. Unspecified medical attention was sought. Laboratory test included MRI cat scan, lime test and rheumatoid test (result unspecified). On 14-NOV-2008 the patient complained that her stomach is bothering her. The patient''s events persisted. Additional information has been requested. 1/12/2009 Reviewed PCP medical records of 6/25/08-1/8/2009. FINAL DX: pain amplification syndrome Records reveal patient experienced intermittent throbbing frontal HA, photophobia & dizziness x 1 mo when seen 10/31/08. RTC 11/5 w/continued HA, chills, hot feeling & sore neck. Exam revealed tender supraventricular nodule. Dx w/viral illness. Neuro consult done 11/6/08. Tx w/steroid taper. Developed joint swelling Rheumatology consult done 12/1/08 & dx w/pain amplification syndrome. This is in follow-up to report(s) previously submitted on 12/12/2008. Follow-up information was received on 15-DEC-2008 from a registered nurse who reported that the female patient was vaccinated with the second dose of GARDASIL (lot number 660553/0070X) in the left deltoid on 26-AUG-2008. In October 2008, the patient experienced headaches for 2 months, chills, sore neck and joint swelling. The patient was referred to see neurologist and rheumatologist. On 06-NOV-2008, the patient was seen by a neurologist. According to the medical record, the patient had no significant past medical history except for frequent nosebleeds and no prior history of headaches. The patient described the headaches as throbbing and predominantly retroorbital in location. The patient also described photophobia and intermittent nausea with no vomiting. The patient did feel somewhat fatigue and felt generally weak. The neurologist asked the patient undergo a MRI scan of the brain to rule out structural cause for her headache as well as an MRV to exclude the possibility of venous sinus thrombus. The neurologist also requested that the patient had a Lyme titer and an erythrocyte sedimentation rate. The neurologist recommended that the patient began a steroid taper taking 40 mg of prednisone daily for two days and then gradually decreasing over the next six days. The neurologist also gave a prescription for TYLENOL No. 3 to use for the patient''s pain. On 01-DEC-2008, the patient was seen by a rheumatologist. According to the medical record, the patient developed pain in both elbows and both knees. The patient did not have morning stiffness. The patient did not have swelling or redness around her joints. The patient found that she slept sore. The patient did not have a fever but felt like she had a tactile temperature and temperature was always normal. The patient also had postprandial abdominal pain? no nausea, vomiting or diarrhea. The laboratory tests showed that CT and MRI of the brain were normal. Her Lyme titer was negative. Her EBV panel was negative as well as parvovirus panel. She had normal complements including C3 and C4. However, one test, which is C3D immune complex that is 70, which is significantly elevated with the upper limits of normal of 8. The rest of immunoglobulins were negative, IgE was normal and thyroid function test was normal as well. Blood work done on 11-10-2008, it was indicative of normal liver and renal panel. The patient had a sed rate of 2, absolutely normal CBC, ANA was negative, rheumatoid factor negative. The patient was treated


Changed on 5/13/2011

336652 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Pennsylvania
Vaccinated:2008-08-26
Onset:2008-10-01
Submitted:2008-12-12
Entered:2008-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0070X / 1 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Abdominal discomfort, Abdominal pain, Anorexia, Antinuclear antibody negative, Arthralgia, Asthenia, Blood immunoglobulin E normal, Blood immunoglobulin G normal, Blood immunoglobulin M normal, Chills, Computerised tomogram normal, Eye pain, Fatigue, Full blood count normal, Headache, Immunoglobulins normal, Influenza like illness, Joint swelling, Musculoskeletal pain, Nausea, Neck pain, Nuclear magnetic resonance imaging brain normal, Nuclear magnetic resonance imaging normal, Photophobia, Sleep disorder, Thyroid function test normal, Venogram, Rheumatoid factor negative, Red blood cell sedimentation rate decreased, Complement factor C4, No reaction on previous exposure to drug, Liver function test normal, Feeling of body temperature change, Renal function test normal, Scan brain, C1 esterase inhibitor test, Epstein-Barr virus test negative, Borrelia test negative, Parvovirus B19 test negative

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: None
Current Illness:
Preexisting Conditions: None PMH: multiple nevi; Epistaxis
Allergies:
Diagnostic Lab Data: Unknown LABS: CT & MRI/MRV brain WNL. ESR, CBC, ANA & RA factor WNL. head computed axial, 11/04/08, normal; magnetic resonance, Head normal; renal function study, 11/10/08, normal; diagnostic laboratory, 70, C3D immune complex; Lyme disease assay, negative; Epstein-Barr virus, negative; serum immunoglobulin E, normal; body temp, normal; complete blood cell, 11/10/08, normal; serum rheumatoid factor, 11/10/08, negative; serum ANA, 11/10/08, negative; erythrocyte, 11/10/08, 2, negative; hepatic function tests, 11/10/08, normal; thyroid function test, normal; serum immunoglobin G, negative; serum B39 virus IgM, negative; component C3 test, normal; component C4 test, normal
CDC 'Split Type': WAES0811USA02286

Write-up:Information has been received from a consumer concerning her 17 year old daughter with no relevant medical history or allergies who on approximately 23-JUN-2008, was vaccinated with a first dose of GARDASIL (lot number, injection site and route not reported). The patient did not have adverse reaction after receiving the first dose. On 25-AUG-2008 the patient was vaccinated with a second dose of GARDASIL (lot number, injection site and route not reported). There was no concomitant medication. In the first week of October 2008, the patient experienced constant headache, loss of appetite, flu like symptoms and joint swelling. Unspecified medical attention was sought. Laboratory test included MRI cat scan, lime test and rheumatoid test (result unspecified). On 14-NOV-2008 the patient complained that her stomach is bothering her. The patient''s events persisted. Additional information has been requested. 1/12/2009 Reviewed PCP medical records of 6/25/08-1/8/2009. FINAL DX: pain amplification syndrome Records reveal patient experienced intermittent throbbing frontal HA, photophobia & dizziness x 1 mo when seen 10/31/08. RTC 11/5 w/continued HA, chills, hot feeling & sore neck. Exam revealed tender supraventricular nodule. Dx w/viral illness. Neuro consult done 11/6/08. Tx w/steroid taper. Developed joint swelling Rheumatology consult done 12/1/08 & dx w/pain amplification syndrome. This is in follow-up to report(s) previously submitted on 12/12/2008. Follow-up information was received on 15-DEC-2008 from a registered nurse who reported that the female patient was vaccinated with the second dose of GARDASIL (lot number 660553/0070X) in the left deltoid on 26-AUG-2008. In October 2008, the patient experienced headaches for 2 months, chills, sore neck and joint swelling. The patient was referred to see neurologist and rheumatologist. On 06-NOV-2008, the patient was seen by a neurologist. According to the medical record, the patient had no significant past medical history except for frequent nosebleeds and no prior history of headaches. The patient described the headaches as throbbing and predominantly retroorbital in location. The patient also described photophobia and intermittent nausea with no vomiting. The patient did feel somewhat fatigue and felt generally weak. The neurologist asked the patient undergo a MRI scan of the brain to rule out structural cause for her headache as well as an MRV to exclude the possibility of venous sinus thrombus. The neurologist also requested that the patient had a Lyme titer and an erythrocyte sedimentation rate. The neurologist recommended that the patient began a steroid taper taking 40 mg of prednisone daily for two days and then gradually decreasing over the next six days. The neurologist also gave a prescription for TYLENOL No. 3 to use for the patient''s pain. On 01-DEC-2008, the patient was seen by a rheumatologist. According to the medical record, the patient developed pain in both elbows and both knees. The patient did not have morning stiffness. The patient did not have swelling or redness around her joints. The patient found that she slept sore. The patient did not have a fever but felt like she had a tactile temperature and temperature was always normal. The patient also had postprandial abdominal pain? no nausea, vomiting or diarrhea. The laboratory tests showed that CT and MRI of the brain were normal. Her Lyme titer was negative. Her EBV panel was negative as well as parvovirus panel. She had normal complements including C3 and C4. However, one test, which is C3D immune complex that is 70, which is significantly elevated with the upper limits of normal of 8. The rest of immunoglobulins were negative, IgE was normal and thyroid function test was normal as well. Blood work done on 11-10-2008, it was indicative of normal liver and renal panel. The patient had a sed rate of 2, absolutely normal CBC, ANA was negative, rheumatoid factor negative. The patient was treated


Changed on 6/11/2011

336652 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Pennsylvania
Vaccinated:2008-08-26
Onset:2008-10-01
Submitted:2008-12-12
Entered:2008-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0070X / 1 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Abdominal discomfort, Abdominal pain, Anorexia, Antinuclear antibody negative, Arthralgia, Asthenia, Blood immunoglobulin E normal, Blood immunoglobulin G normal, Blood immunoglobulin M normal, Chills, Computerised tomogram normal, Eye pain, Fatigue, Full blood count normal, Headache, Immunoglobulins normal, Influenza like illness, Joint swelling, Musculoskeletal pain, Nausea, Neck pain, Nuclear magnetic resonance imaging brain normal, Nuclear magnetic resonance imaging normal, Photophobia, Sleep disorder, Thyroid function test normal, Venogram, Rheumatoid factor negative, Red blood cell sedimentation rate decreased, Complement factor C4, No reaction on previous exposure to drug, Liver function test normal, Feeling of body temperature change, Renal function test normal, Scan brain, C1 esterase inhibitor test, Epstein-Barr virus test negative, Borrelia test negative, Parvovirus B19 test negative

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: None
Current Illness:
Preexisting Conditions: None PMH: multiple nevi; Epistaxis
Allergies:
Diagnostic Lab Data: Unknown LABS: CT & MRI/MRV brain WNL. ESR, CBC, ANA & RA factor WNL. head computed axial, 11/04/08, normal; magnetic resonance, Head normal; renal function study, 11/10/08, normal; diagnostic laboratory, 70, C3D immune complex; Lyme disease assay, negative; Epstein-Barr virus, negative; serum immunoglobulin E, normal; body temp, normal; complete blood cell, 11/10/08, normal; serum rheumatoid factor, 11/10/08, negative; serum ANA, 11/10/08, negative; erythrocyte, 11/10/08, 2, negative; hepatic function tests, 11/10/08, normal; thyroid function test, normal; serum immunoglobin G, negative; serum B39 virus IgM, negative; component C3 test, normal; component C4 test, normal
CDC 'Split Type': WAES0811USA02286

Write-up:Information has been received from a consumer concerning her 17 year old daughter with no relevant medical history or allergies who on approximately 23-JUN-2008, was vaccinated with a first dose of GARDASIL (lot number, injection site and route not reported). The patient did not have adverse reaction after receiving the first dose. On 25-AUG-2008 the patient was vaccinated with a second dose of GARDASIL (lot number, injection site and route not reported). There was no concomitant medication. In the first week of October 2008, the patient experienced constant headache, loss of appetite, flu like symptoms and joint swelling. Unspecified medical attention was sought. Laboratory test included MRI cat scan, lime test and rheumatoid test (result unspecified). On 14-NOV-2008 the patient complained that her stomach is bothering her. The patient''s events persisted. Additional information has been requested. 1/12/2009 Reviewed PCP medical records of 6/25/08-1/8/2009. FINAL DX: pain amplification syndrome Records reveal patient experienced intermittent throbbing frontal HA, photophobia & dizziness x 1 mo when seen 10/31/08. RTC 11/5 w/continued HA, chills, hot feeling & sore neck. Exam revealed tender supraventricular nodule. Dx w/viral illness. Neuro consult done 11/6/08. Tx w/steroid taper. Developed joint swelling Rheumatology consult done 12/1/08 & dx w/pain amplification syndrome. This is in follow-up to report(s) previously submitted on 12/12/2008. Follow-up information was received on 15-DEC-2008 from a registered nurse who reported that the female patient was vaccinated with the second dose of GARDASIL (lot number 660553/0070X) in the left deltoid on 26-AUG-2008. In October 2008, the patient experienced headaches for 2 months, chills, sore neck and joint swelling. The patient was referred to see neurologist and rheumatologist. On 06-NOV-2008, the patient was seen by a neurologist. According to the medical record, the patient had no significant past medical history except for frequent nosebleeds and no prior history of headaches. The patient described the headaches as throbbing and predominantly retroorbital in location. The patient also described photophobia and intermittent nausea with no vomiting. The patient did feel somewhat fatigue and felt generally weak. The neurologist asked the patient undergo a MRI scan of the brain to rule out structural cause for her headache as well as an MRV to exclude the possibility of venous sinus thrombus. The neurologist also requested that the patient had a Lyme titer and an erythrocyte sedimentation rate. The neurologist recommended that the patient began a steroid taper taking 40 mg of prednisone daily for two days and then gradually decreasing over the next six days. The neurologist also gave a prescription for TYLENOL No. 3 to use for the patient''s pain. On 01-DEC-2008, the patient was seen by a rheumatologist. According to the medical record, the patient developed pain in both elbows and both knees. The patient did not have morning stiffness. The patient did not have swelling or redness around her joints. The patient found that she slept sore. The patient did not have a fever but felt like she had a tactile temperature and temperature was always normal. The patient also had postprandial abdominal pain? no nausea, vomiting or diarrhea. The laboratory tests showed that CT and MRI of the brain were normal. Her Lyme titer was negative. Her EBV panel was negative as well as parvovirus panel. She had normal complements including C3 and C4. However, one test, which is C3D immune complex that is 70, which is significantly elevated with the upper limits of normal of 8. The rest of immunoglobulins were negative, IgE was normal and thyroid function test was normal as well. Blood work done on 11-10-2008, it was indicative of normal liver and renal panel. The patient had a sed rate of 2, absolutely normal CBC, ANA was negative, rheumatoid factor negative. The patient was treated


Changed on 6/14/2014

336652 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Pennsylvania
Vaccinated:2008-08-26
Onset:2008-10-01
Submitted:2008-12-12
Entered:2008-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0070X / 1 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Abdominal discomfort, Abdominal pain, Anorexia, Antinuclear antibody negative, Arthralgia, Asthenia, Blood immunoglobulin E normal, Blood immunoglobulin G normal, Blood immunoglobulin M normal, Chills, Computerised tomogram normal, Eye pain, Fatigue, Full blood count normal, Headache, Immunoglobulins normal, Influenza like illness, Joint swelling, Musculoskeletal pain, Nausea, Neck pain, Nuclear magnetic resonance imaging brain normal, Nuclear magnetic resonance imaging normal, Photophobia, Sleep disorder, Thyroid function test normal, Venogram, Rheumatoid factor negative, Red blood cell sedimentation rate decreased, Complement factor C4, No reaction on previous exposure to drug, Liver function test normal, Feeling of body temperature change, Renal function test normal, Scan brain, C1 esterase inhibitor test, Epstein-Barr virus test negative, Borrelia test negative, Parvovirus B19 test negative

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: None
Current Illness:
Preexisting Conditions: None PMH: multiple nevi; Epistaxis
Allergies:
Diagnostic Lab Data: Unknown LABS: CT & MRI/MRV brain WNL. ESR, CBC, ANA & RA factor WNL. head computed axial, 11/04/08, normal; magnetic resonance, Head normal; renal function study, 11/10/08, normal; diagnostic laboratory, 70, C3D immune complex; Lyme disease assay, negative; Epstein-Barr virus, negative; serum immunoglobulin E, normal; body temp, normal; complete blood cell, 11/10/08, normal; serum rheumatoid factor, 11/10/08, negative; serum ANA, 11/10/08, negative; erythrocyte, 11/10/08, 2, negative; hepatic function tests, 11/10/08, normal; thyroid function test, normal; serum immunoglobin G, negative; serum B39 virus IgM, negative; component C3 test, normal; component C4 test, normal
CDC 'Split Type': WAES0811USA02286

Write-up:Information has been received from a consumer concerning her 17 year old daughter with no relevant medical history or allergies who on approximately 23-JUN-2008, was vaccinated with a first dose of GARDASIL (lot number, injection site and route not reported). The patient did not have adverse reaction after receiving the first dose. On 25-AUG-2008 the patient was vaccinated with a second dose of GARDASIL (lot number, injection site and route not reported). There was no concomitant medication. In the first week of October 2008, the patient experienced constant headache, loss of appetite, flu like symptoms and joint swelling. Unspecified medical attention was sought. Laboratory test included MRI cat scan, lime test and rheumatoid test (result unspecified). On 14-NOV-2008 the patient complained that her stomach is bothering her. The patient''s events persisted. Additional information has been requested. 1/12/2009 Reviewed PCP medical records of 6/25/08-1/8/2009. FINAL DX: pain amplification syndrome Records reveal patient experienced intermittent throbbing frontal HA, photophobia & dizziness x 1 mo when seen 10/31/08. RTC 11/5 w/continued HA, chills, hot feeling & sore neck. Exam revealed tender supraventricular nodule. Dx w/viral illness. Neuro consult done 11/6/08. Tx w/steroid taper. Developed joint swelling Rheumatology consult done 12/1/08 & dx w/pain amplification syndrome. This is in follow-up to report(s) previously submitted on 12/12/2008. Follow-up information was received on 15-DEC-2008 from a registered nurse who reported that the female patient was vaccinated with the second dose of GARDASIL (lot number 660553/0070X) in the left deltoid on 26-AUG-2008. In October 2008, the patient experienced headaches for 2 months, chills, sore neck and joint swelling. The patient was referred to see neurologist and rheumatologist. On 06-NOV-2008, the patient was seen by a neurologist. According to the medical record, the patient had no significant past medical history except for frequent nosebleeds and no prior history of headaches. The patient described the headaches as throbbing and predominantly retroorbital in location. The patient also described photophobia and intermittent nausea with no vomiting. The patient did feel somewhat fatigue and felt generally weak. The neurologist asked the patient undergo a MRI scan of the brain to rule out structural cause for her headache as well as an MRV to exclude the possibility of venous sinus thrombus. The neurologist also requested that the patient had a Lyme titer and an erythrocyte sedimentation rate. The neurologist recommended that the patient began a steroid taper taking 40 mg of prednisone daily for two days and then gradually decreasing over the next six days. The neurologist also gave a prescription for TYLENOL No. 3 to use for the patient''s pain. On 01-DEC-2008, the patient was seen by a rheumatologist. According to the medical record, the patient developed pain in both elbows and both knees. The patient did not have morning stiffness. The patient did not have swelling or redness around her joints. The patient found that she slept sore. The patient did not have a fever but felt like she had a tactile temperature and temperature was always normal. The patient also had postprandial abdominal pain? no nausea, vomiting or diarrhea. The laboratory tests showed that CT and MRI of the brain were normal. Her Lyme titer was negative. Her EBV panel was negative as well as parvovirus panel. She had normal complements including C3 and C4. However, one test, which is C3D immune complex that is 70, which is significantly elevated with the upper limits of normal of 8. The rest of immunoglobulins were negative, IgE was normal and thyroid function test was normal as well. Blood work done on 11-10-2008, it was indicative of normal liver and renal panel. The patient had a sed rate of 2, absolutely normal CBC, ANA was negative, rheumatoid factor negative. The patient was treated


Changed on 4/14/2017

336652 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Pennsylvania
Vaccinated:2008-08-26
Onset:2008-10-01
Submitted:2008-12-12
Entered:2008-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0070X / 1 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Abdominal discomfort, Abdominal pain, Anorexia, Antinuclear antibody negative, Arthralgia, Asthenia, Blood immunoglobulin E normal, Blood immunoglobulin G normal, Blood immunoglobulin M normal, Chills, Computerised tomogram normal, Eye pain, Fatigue, Full blood count normal, Headache, Immunoglobulins normal, Influenza like illness, Joint swelling, Musculoskeletal pain, Nausea, Neck pain, Nuclear magnetic resonance imaging brain normal, Nuclear magnetic resonance imaging normal, Photophobia, Sleep disorder, Thyroid function test normal, Venogram, Rheumatoid factor negative, Red blood cell sedimentation rate decreased, Complement factor C4, No reaction on previous exposure to drug, Liver function test normal, Feeling of body temperature change, Renal function test normal, Scan brain, C1 esterase inhibitor test, Epstein-Barr virus test negative, Borrelia test negative, Parvovirus B19 test negative

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: None
Current Illness:
Preexisting Conditions: None PMH: multiple nevi; Epistaxis
Allergies:
Diagnostic Lab Data: Unknown LABS: CT & MRI/MRV brain WNL. ESR, CBC, ANA & RA factor WNL. head computed axial, 11/04/08, normal; magnetic resonance, Head normal; renal function study, 11/10/08, normal; diagnostic laboratory, 70, C3D immune complex; Lyme disease assay, negative; Epstein-Barr virus, negative; serum immunoglobulin E, normal; body temp, normal; complete blood cell, 11/10/08, normal; serum rheumatoid factor, 11/10/08, negative; serum ANA, 11/10/08, negative; erythrocyte, 11/10/08, 2, negative; hepatic function tests, 11/10/08, normal; thyroid function test, normal; serum immunoglobin G, negative; serum B39 virus IgM, negative; component C3 test, normal; component C4 test, normal
CDC 'Split Type': WAES0811USA02286

Write-up:Information has been received from a consumer concerning her 17 year old daughter with no relevant medical history or allergies who on approximately 23-JUN-2008, was vaccinated with a first dose of GARDASIL (lot number, injection site and route not reported). The patient did not have adverse reaction after receiving the first dose. On 25-AUG-2008 the patient was vaccinated with a second dose of GARDASIL (lot number, injection site and route not reported). There was no concomitant medication. In the first week of October 2008, the patient experienced constant headache, loss of appetite, flu like symptoms and joint swelling. Unspecified medical attention was sought. Laboratory test included MRI cat scan, lime test and rheumatoid test (result unspecified). On 14-NOV-2008 the patient complained that her stomach is bothering her. The patient''s events persisted. Additional information has been requested. 1/12/2009 Reviewed PCP medical records of 6/25/08-1/8/2009. FINAL DX: pain amplification syndrome Records reveal patient experienced intermittent throbbing frontal HA, photophobia & dizziness x 1 mo when seen 10/31/08. RTC 11/5 w/continued HA, chills, hot feeling & sore neck. Exam revealed tender supraventricular nodule. Dx w/viral illness. Neuro consult done 11/6/08. Tx w/steroid taper. Developed joint swelling Rheumatology consult done 12/1/08 & dx w/pain amplification syndrome. This is in follow-up to report(s) previously submitted on 12/12/2008. Follow-up information was received on 15-DEC-2008 from a registered nurse who reported that the female patient was vaccinated with the second dose of GARDASIL (lot number 660553/0070X) in the left deltoid on 26-AUG-2008. In October 2008, the patient experienced headaches for 2 months, chills, sore neck and joint swelling. The patient was referred to see neurologist and rheumatologist. On 06-NOV-2008, the patient was seen by a neurologist. According to the medical record, the patient had no significant past medical history except for frequent nosebleeds and no prior history of headaches. The patient described the headaches as throbbing and predominantly retroorbital in location. The patient also described photophobia and intermittent nausea with no vomiting. The patient did feel somewhat fatigue and felt generally weak. The neurologist asked the patient undergo a MRI scan of the brain to rule out structural cause for her headache as well as an MRV to exclude the possibility of venous sinus thrombus. The neurologist also requested that the patient had a Lyme titer and an erythrocyte sedimentation rate. The neurologist recommended that the patient began a steroid taper taking 40 mg of prednisone daily for two days and then gradually decreasing over the next six days. The neurologist also gave a prescription for TYLENOL No. 3 to use for the patient''s pain. On 01-DEC-2008, the patient was seen by a rheumatologist. According to the medical record, the patient developed pain in both elbows and both knees. The patient did not have morning stiffness. The patient did not have swelling or redness around her joints. The patient found that she slept sore. The patient did not have a fever but felt like she had a tactile temperature and temperature was always normal. The patient also had postprandial abdominal pain? no nausea, vomiting or diarrhea. The laboratory tests showed that CT and MRI of the brain were normal. Her Lyme titer was negative. Her EBV panel was negative as well as parvovirus panel. She had normal complements including C3 and C4. However, one test, which is C3D immune complex that is 70, which is significantly elevated with the upper limits of normal of 8. The rest of immunoglobulins were negative, IgE was normal and thyroid function test was normal as well. Blood work done on 11-10-2008, it was indicative of normal liver and renal panel. The patient had a sed rate of 2, absolutely normal CBC, ANA was negative, rheumatoid factor negative. The patient was treated with


Changed on 9/14/2017

336652 Before After
VAERS Form:(blank) 1
Age:16.0
Gender:Female
Location:Pennsylvania
Vaccinated:2008-08-26
Onset:2008-10-01
Submitted:2008-12-12
Entered:2008-12-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0070X / 1 2 LA / IM

Administered by: Private      Purchased by: Other
Symptoms: Abdominal discomfort, Abdominal pain, Anorexia, Arthralgia, Asthenia, Blood immunoglobulin E normal, Blood immunoglobulin G normal, Blood immunoglobulin M normal, Eye pain, Fatigue, Full blood count normal, Headache, Immunoglobulins normal, Influenza like illness, Joint swelling, Musculoskeletal pain, Nausea, Neck pain, Nuclear magnetic resonance imaging normal, Sleep disorder, Thyroid function test normal, Venogram, Red blood cell sedimentation rate decreased, Complement factor C4, No reaction on previous exposure to drug, Liver function test normal, Feeling of body temperature change, Renal function test normal, Scan brain, C1 esterase inhibitor test, Epstein-Barr virus test negative, Borrelia test negative, Parvovirus B19 test negative

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: None
Current Illness:
Preexisting Conditions: None PMH: multiple nevi; Epistaxis
Allergies:
Diagnostic Lab Data: Unknown LABS: CT & MRI/MRV brain WNL. ESR, CBC, ANA & RA factor WNL. head computed axial, 11/04/08, normal; magnetic resonance, Head normal; renal function study, 11/10/08, normal; diagnostic laboratory, 70, C3D immune complex; Lyme disease assay, negative; Epstein-Barr virus, negative; serum immunoglobulin E, normal; body temp, normal; complete blood cell, 11/10/08, normal; serum rheumatoid factor, 11/10/08, negative; serum ANA, 11/10/08, negative; erythrocyte, 11/10/08, 2, negative; hepatic function tests, 11/10/08, normal; thyroid function test, normal; serum immunoglobin G, negative; serum B39 virus IgM, negative; component C3 test, normal; component C4 test, normal
CDC 'Split Type': WAES0811USA02286

Write-up:Information has been received from a consumer concerning her 17 year old daughter with no relevant medical history or allergies who on approximately 23-JUN-2008, was vaccinated with a first dose of GARDASIL (lot number, injection site and route not reported). The patient did not have adverse reaction after receiving the first dose. On 25-AUG-2008 the patient was vaccinated with a second dose of GARDASIL (lot number, injection site and route not reported). There was no concomitant medication. In the first week of October 2008, the patient experienced constant headache, loss of appetite, flu like symptoms and joint swelling. Unspecified medical attention was sought. Laboratory test included MRI cat scan, lime test and rheumatoid test (result unspecified). On 14-NOV-2008 the patient complained that her stomach is bothering her. The patient''s events persisted. Additional information has been requested. 1/12/2009 Reviewed PCP medical records of 6/25/08-1/8/2009. FINAL DX: pain amplification syndrome Records reveal patient experienced intermittent throbbing frontal HA, photophobia & dizziness x 1 mo when seen 10/31/08. RTC 11/5 w/continued HA, chills, hot feeling & sore neck. Exam revealed tender supraventricular nodule. Dx w/viral illness. Neuro consult done 11/6/08. Tx w/steroid taper. Developed joint swelling Rheumatology consult done 12/1/08 & dx w/pain amplification syndrome. This is in follow-up to report(s) previously submitted on 12/12/2008. Follow-up information was received on 15-DEC-2008 from a registered nurse who reported that the female patient was vaccinated with the second dose of GARDASIL (lot number 660553/0070X) in the left deltoid on 26-AUG-2008. In October 2008, the patient experienced headaches for 2 months, chills, sore neck and joint swelling. The patient was referred to see neurologist and rheumatologist. On 06-NOV-2008, the patient was seen by a neurologist. According to the medical record, the patient had no significant past medical history except for frequent nosebleeds and no prior history of headaches. The patient described the headaches as throbbing and predominantly retroorbital in location. The patient also described photophobia and intermittent nausea with no vomiting. The patient did feel somewhat fatigue and felt generally weak. The neurologist asked the patient undergo a MRI scan of the brain to rule out structural cause for her headache as well as an MRV to exclude the possibility of venous sinus thrombus. The neurologist also requested that the patient had a Lyme titer and an erythrocyte sedimentation rate. The neurologist recommended that the patient began a steroid taper taking 40 mg of prednisone daily for two days and then gradually decreasing over the next six days. The neurologist also gave a prescription for TYLENOL No. 3 to use for the patient''s pain. On 01-DEC-2008, the patient was seen by a rheumatologist. According to the medical record, the patient developed pain in both elbows and both knees. The patient did not have morning stiffness. The patient did not have swelling or redness around her joints. The patient found that she slept sore. The patient did not have a fever but felt like she had a tactile temperature and temperature was always normal. The patient also had postprandial abdominal pain? no nausea, vomiting or diarrhea. The laboratory tests showed that CT and MRI of the brain were normal. Her Lyme titer was negative. Her EBV panel was negative as well as parvovirus panel. She had normal complements including C3 and C4. However, one test, which is C3D immune complex that is 70, which is significantly elevated with the upper limits of normal of 8. The rest of immunoglobulins were negative, IgE was normal and thyroid function test was normal as well. Blood work done on 11-10-2008, it was indicative of normal liver and renal panel. The patient had a sed rate of 2, absolutely normal CBC, ANA was negative, rheumatoid factor negative. The patient was treated with prednisone for one week. The patient was off prednisone "for the past eight days". The patient stated that treatment prescribed by the neurologist did not result in any changes in her headache pattern. The patient also had seen an allergist who did not think that her headaches were related to some allergic condition. The rheumatologist did not think that the patient''s ache and pains were due to autoimmune inflammatory process. The rheumatologist regarded this phenomenon as "pain amplification syndrome". The rheumatologist recommended aerobic exercise which needed to be increased gradually and improvement in quality of sleep. Additional information is not expected.


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