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This is VAERS ID 340357

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

340357
VAERS Form:
Age:15.0
Gender:Female
Location:Florida
Vaccinated:2009-01-16
Onset:2009-01-22
Submitted:2009-02-13
Entered:2009-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0575X / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Blood glucose increased, Bronchitis, Chest X-ray normal, Dizziness, Electrocardiogram normal, Haemoglobin increased, Influenza like illness, Loss of consciousness, Lymphocyte count decreased, Malaise, Mydriasis, Nausea, Neutrophil count increased, Pain, Pallor, Pyrexia, Syncope, Tooth injury, White blood cell count decreased, Mouth injury, Suture insertion

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: not at time of vaccination
Current Illness: None
Preexisting Conditions: allergic to Amoxicillin
Allergies:
Diagnostic Lab Data: EKG, normal; Chest X-ray, showed bronchitis 3/16/09-records received-WBC 3.2, Hgb 14.9, neutrophils elevated 77.8, lymphocytes decreased 15.4, glucose 110. Chest x-ray normal.
CDC 'Split Type':

Write-up:Patient received her 1st GARDASIL shot on 1-16-09. She received no other shots and was on no medication. On 1-20-09, patient woke up with flu-like symptoms fever, upper respiratory congestion, body aches, and weakness. On 1-22-09, patient was treated at urgent care for her flu-like symptoms and bronchitis. She was given a 1st dose of Azithromycin, PREDNISONE and MUCINEX mid-morning. After sleeping for 2 1/2-3hours, patient got up, sat down to eat felt ill, got up, and passed out, hitting her two front teeth and severing them. She went by ambulance to hospital ER, although she regained consciousness right away, her skin was a strange white color and her pupils were dilated. She has had no other problems since her ER treatment, but her two front teeth had to be replaced with crowns. 3/16/09-ED records received for DOS 1/22/08-presented with C/O lightheadness, syncope, nausea, felt faint, brief loss of consciousness. Abrasions on inner lips, oral laceration, suturing required. Dental injury. Impression: syncope.


Changed on 4/14/2017

340357 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Florida
Vaccinated:2009-01-16
Onset:2009-01-22
Submitted:2009-02-13
Entered:2009-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0575X / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Blood glucose increased, Bronchitis, Chest X-ray normal, Dizziness, Electrocardiogram normal, Haemoglobin increased, Influenza like illness, Loss of consciousness, Lymphocyte count decreased, Malaise, Mydriasis, Nausea, Neutrophil count increased, Pain, Pallor, Pyrexia, Syncope, Tooth injury, White blood cell count decreased, Mouth injury, Suture insertion

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: not at time of vaccination
Current Illness: None
Preexisting Conditions: allergic to Amoxicillin
Allergies:
Diagnostic Lab Data: EKG, normal; Chest X-ray, showed bronchitis 3/16/09-records received-WBC 3.2, Hgb 14.9, neutrophils elevated 77.8, lymphocytes decreased 15.4, glucose 110. Chest x-ray normal.
CDC 'Split Type':

Write-up:Patient received her 1st GARDASIL shot on 1-16-09. She received no other shots and was on no medication. On 1-20-09, patient woke up with flu-like symptoms fever, upper respiratory congestion, body aches, and weakness. On 1-22-09, patient was treated at urgent care for her flu-like symptoms and bronchitis. She was given a 1st dose of Azithromycin, PREDNISONE and MUCINEX mid-morning. After sleeping for 2 1/2-3hours, patient got up, sat down to eat felt ill, got up, and passed out, hitting her two front teeth and severing them. She went by ambulance to hospital ER, although she regained consciousness right away, her skin was a strange white color and her pupils were dilated. She has had no other problems since her ER treatment, but her two front teeth had to be replaced with crowns. 3/16/09-ED records received for DOS 1/22/08-presented with C/O lightheadness, syncope, nausea, felt faint, brief loss of consciousness. Abrasions on inner lips, oral laceration, suturing required. Dental injury. Impression: syncope.


Changed on 9/14/2017

340357 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:Florida
Vaccinated:2009-01-16
Onset:2009-01-22
Submitted:2009-02-13
Entered:2009-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0575X / 0 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Bronchitis, Electrocardiogram normal, Influenza like illness, Loss of consciousness, Malaise, Mydriasis, Pain, Pallor, Pyrexia, Tooth injury

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: not at time of vaccination
Current Illness: None
Preexisting Conditions: allergic to Amoxicillin
Allergies:
Diagnostic Lab Data: EKG, normal; Chest X-ray, showed bronchitis 3/16/09-records received-WBC 3.2, Hgb 14.9, neutrophils elevated 77.8, lymphocytes decreased 15.4, glucose 110. Chest x-ray normal.
CDC 'Split Type':

Write-up:Patient received her 1st GARDASIL shot on 1-16-09. She received no other shots and was on no medication. On 1-20-09, patient woke up with flu-like symptoms fever, upper respiratory congestion, body aches, and weakness. On 1-22-09, patient was treated at urgent care for her flu-like symptoms and bronchitis. She was given a 1st dose of Azithromycin, PREDNISONE and MUCINEX mid-morning. After sleeping for 2 1/2-3hours, patient got up, sat down to eat felt ill, got up, and passed out, hitting her two front teeth and severing them. She went by ambulance to hospital ER, although she regained consciousness right away, her skin was a strange white color and her pupils were dilated. She has had no other problems since her ER treatment, but her two front teeth had to be replaced with crowns. 3/16/09-ED records received for DOS 1/22/08-presented with C/O lightheadness, syncope, nausea, felt faint, brief loss of consciousness. Abrasions on inner lips, oral laceration, suturing required. Dental injury. Impression: syncope.


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