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This is VAERS ID 344584

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

344584
VAERS Form:
Age:14.0
Gender:Female
Location:New York
Vaccinated:2008-07-22
Onset:2008-08-05
Submitted:2009-04-20
Entered:2009-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0072X / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Antinuclear antibody, Back pain, Blood immunoglobulin A, Blood immunoglobulin G, Blood immunoglobulin M, Blood thyroid stimulating hormone, Cyst, Fatigue, Haemoglobin normal, Migraine, Neck pain, Nuclear magnetic resonance imaging abnormal, Rheumatoid factor, Sacroiliitis, Thyroxine, White blood cell count decreased, X-ray normal, Activities of daily living impaired, Complement factor C3, Complement factor C4, Adnexa uteri mass, Liver function test normal, DNA antibody, Inflammation, HLA marker study, Streptococcus identification test positive, Streptococcus identification test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: FOLIC ACID; METHOTREXATE; PREVACID; TRAUIADOL; ENBRIL
Current Illness: None
Preexisting Conditions: H/O "Burning" sensation of feet 5/19/08-records received-PMH:eczema. foot burning, foot pain in 2005 and 2006.
Allergies:
Diagnostic Lab Data: Negative HLA-B27; 9-11-08 Hg 12.5, Wbc5 100; Normal LFTS; U/A; IgG, A, ME, C3 C4; ANA; DNAA; RF ASO; Aule SSA & B; acute DNA SE, TY, TSH 5/19/09-records received-Laboratory tests normal. 9/3/08-x-rays demonstrate open growth plates of vert
CDC 'Split Type':

Write-up:Since 8/5/08, 2 wks after her 2nd GARDASIL shot, this girl has had severe back pain with diagnosis of Sacroileitis, pain Amplification syndrome. Pain 7/10, fatigued. Her best friend developed severity arthritis too after vaccine recently has missed 35 d of school 2008-9 5/19/09-records received-Office note 7/22/08 SI joint inflammed, positive for strep antibody. Right complex adnexal cyst. 9/25/08-bulging L4/5, C/O pain when walking. 4/2/09-back pain no relief. Orthopaedic evaluation 8/29/08-orthopaedic evaluation. C/O bilateral should pain began 1 week prior now low back pain and upper back pain. Migraine headaches in past. Impression: acute back pain of unlear etiology. Impression: thoracic back pain of unclear etiology. 9/5/08-worsening back pain, impression:thoracic pain with component of cervical pain. Rheumatology consult 10/2/08-impression:pain amplification.


Changed on 3/2/2010

344584 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:New York
Vaccinated:2008-07-22
Onset:2008-08-05
Submitted:2009-04-20
Entered:2009-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0072X / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Antinuclear antibody, Back pain, Blood immunoglobulin A, Blood immunoglobulin G, Blood immunoglobulin M, Blood thyroid stimulating hormone, Cyst, Fatigue, Haemoglobin normal, Migraine, Neck pain, Nuclear magnetic resonance imaging abnormal, Rheumatoid factor, Sacroiliitis, Thyroxine, White blood cell count decreased, X-ray normal, Activities of daily living impaired, Complement factor C3, Complement factor C4, Adnexa uteri mass, Liver function test normal, DNA antibody, Inflammation, HLA marker study, Streptococcus identification test positive, Streptococcus identification test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: FOLIC ACID; METHOTREXATE; PREVACID; TRAUIADOL; ENBRIL
Current Illness: None
Preexisting Conditions: H/O "Burning" sensation of feet 5/19/08-records received-PMH:eczema. foot burning, foot pain in 2005 and 2006.
Allergies:
Diagnostic Lab Data: Negative HLA-B27; 9-11-08 Hg 12.5, Wbc5 100; Normal LFTS; U/A; IgG, A, ME, C3 C4; ANA; DNAA; RF ASO; Aule SSA & B; acute DNA SE, TY, TSH 5/19/09-records received-Laboratory tests normal. 9/3/08-x-rays demonstrate open growth plates of vert
CDC 'Split Type':

Write-up:Since 8/5/08, 2 wks after her 2nd GARDASIL shot, this girl has had severe back pain with diagnosis of Sacroileitis, pain Amplification syndrome. Pain 7/10, fatigued. Her best friend developed severity arthritis too after vaccine recently has missed 35 d of school 2008-9 5/19/09-records received-Office note 7/22/08 SI joint inflammed, positive for strep antibody. Right complex adnexal cyst. 9/25/08-bulging L4/5, C/O pain when walking. 4/2/09-back pain no relief. Orthopaedic evaluation 8/29/08-orthopaedic evaluation. C/O bilateral should pain began 1 week prior now low back pain and upper back pain. Migraine headaches in past. Impression: acute back pain of unlear etiology. Impression: thoracic back pain of unclear etiology. 9/5/08-worsening back pain, impression:thoracic pain with component of cervical pain. Rheumatology consult 10/2/08-impression:pain amplification.


Changed on 4/7/2010

344584 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:New York
Vaccinated:2008-07-22
Onset:2008-08-05
Submitted:2009-04-20
Entered:2009-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0072X / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Antinuclear antibody, Back pain, Blood immunoglobulin A, Blood immunoglobulin G, Blood immunoglobulin M, Blood thyroid stimulating hormone, Cyst, Fatigue, Haemoglobin normal, Migraine, Neck pain, Nuclear magnetic resonance imaging abnormal, Rheumatoid factor, Sacroiliitis, Thyroxine, White blood cell count decreased, X-ray normal, Activities of daily living impaired, Complement factor C3, Complement factor C4, Adnexa uteri mass, Liver function test normal, DNA antibody, Inflammation, HLA marker study, Streptococcus identification test positive, Streptococcus identification test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: FOLIC ACID; METHOTREXATE; PREVACID; TRAUIADOL; ENBRIL
Current Illness: None
Preexisting Conditions: H/O "Burning" sensation of feet 5/19/08-records received-PMH:eczema. foot burning, foot pain in 2005 and 2006.
Allergies:
Diagnostic Lab Data: Negative HLA-B27; 9-11-08 Hg 12.5, Wbc5 100; Normal LFTS; U/A; IgG, A, ME, C3 C4; ANA; DNAA; RF ASO; Aule SSA & B; acute DNA SE, TY, TSH 5/19/09-records received-Laboratory tests normal. 9/3/08-x-rays demonstrate open growth plates of vert
CDC 'Split Type':

Write-up:Since 8/5/08, 2 wks after her 2nd GARDASIL shot, this girl has had severe back pain with diagnosis of Sacroileitis, pain Amplification syndrome. Pain 7/10, fatigued. Her best friend developed severity arthritis too after vaccine recently has missed 35 d of school 2008-9 5/19/09-records received-Office note 7/22/08 SI joint inflammed, positive for strep antibody. Right complex adnexal cyst. 9/25/08-bulging L4/5, C/O pain when walking. 4/2/09-back pain no relief. Orthopaedic evaluation 8/29/08-orthopaedic evaluation. C/O bilateral should pain began 1 week prior now low back pain and upper back pain. Migraine headaches in past. Impression: acute back pain of unlear etiology. Impression: thoracic back pain of unclear etiology. 9/5/08-worsening back pain, impression:thoracic pain with component of cervical pain. Rheumatology consult 10/2/08-impression:pain amplification.


Changed on 7/31/2010

344584 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:New York
Vaccinated:2008-07-22
Onset:2008-08-05
Submitted:2009-04-20
Entered:2009-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0072X / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Antinuclear antibody, Back pain, Blood immunoglobulin A, Blood immunoglobulin G, Blood immunoglobulin M, Blood thyroid stimulating hormone, Cyst, Fatigue, Haemoglobin normal, Migraine, Neck pain, Nuclear magnetic resonance imaging abnormal, Rheumatoid factor, Sacroiliitis, Thyroxine, White blood cell count decreased, X-ray normal, Activities of daily living impaired, Complement factor C3, Complement factor C4, Adnexa uteri mass, Liver function test normal, DNA antibody, Inflammation, HLA marker study, Streptococcus identification test positive, Streptococcus identification test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: FOLIC ACID; METHOTREXATE; PREVACID; TRAUIADOL; ENBRIL
Current Illness: None
Preexisting Conditions: H/O "Burning" sensation of feet 5/19/08-records received-PMH:eczema. foot burning, foot pain in 2005 and 2006.
Allergies:
Diagnostic Lab Data: Negative HLA-B27; 9-11-08 Hg 12.5, Wbc5 100; Normal LFTS; U/A; IgG, A, ME, C3 C4; ANA; DNAA; RF ASO; Aule SSA & B; acute DNA SE, TY, TSH 5/19/09-records received-Laboratory tests normal. 9/3/08-x-rays demonstrate open growth plates of vert
CDC 'Split Type':

Write-up:Since 8/5/08, 2 wks after her 2nd GARDASIL shot, this girl has had severe back pain with diagnosis of Sacroileitis, pain Amplification syndrome. Pain 7/10, fatigued. Her best friend developed severity arthritis too after vaccine recently has missed 35 d of school 2008-9 5/19/09-records received-Office note 7/22/08 SI joint inflammed, positive for strep antibody. Right complex adnexal cyst. 9/25/08-bulging L4/5, C/O pain when walking. 4/2/09-back pain no relief. Orthopaedic evaluation 8/29/08-orthopaedic evaluation. C/O bilateral should pain began 1 week prior now low back pain and upper back pain. Migraine headaches in past. Impression: acute back pain of unlear etiology. Impression: thoracic back pain of unclear etiology. 9/5/08-worsening back pain, impression:thoracic pain with component of cervical pain. Rheumatology consult 10/2/08-impression:pain amplification.


Changed on 8/31/2010

344584 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:New York
Vaccinated:2008-07-22
Onset:2008-08-05
Submitted:2009-04-20
Entered:2009-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0072X / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Antinuclear antibody, Back pain, Blood immunoglobulin A, Blood immunoglobulin G, Blood immunoglobulin M, Blood thyroid stimulating hormone, Fatigue, Haemoglobin normal, Rheumatoid factor, Sacroiliitis, Thyroxine, White blood cell count decreased, Activities of daily living impaired, Complement factor C3, Complement factor C4, Adnexa uteri mass, Liver function test normal, DNA antibody, HLA marker study, Streptococcus identification test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: FOLIC ACID; METHOTREXATE; PREVACID; TRAUIADOL; ENBRIL
Current Illness: None
Preexisting Conditions: H/O "Burning" sensation of feet 5/19/08-records received-PMH:eczema. foot burning, foot pain in 2005 and 2006.
Allergies:
Diagnostic Lab Data: Negative HLA-B27; 9-11-08 Hg 12.5, Wbc5 100; Normal LFTS; U/A; IgG, A, ME, C3 C4; ANA; DNAA; RF ASO; Aule SSA & B; acute DNA SE, TY, TSH 5/19/09-records received-Laboratory tests normal. 9/3/08-x-rays demonstrate open growth plates of vert
CDC 'Split Type':

Write-up:Since 8/5/08, 2 wks after her 2nd GARDASIL shot, this girl has had severe back pain with diagnosis of Sacroileitis, pain Amplification syndrome. Pain 7/10, fatigued. Her best friend developed severity arthritis too after vaccine recently has missed 35 d of school 2008-9 5/19/09-records received-Office note 7/22/08 SI joint inflammed, positive for strep antibody. Right complex adnexal cyst. 9/25/08-bulging L4/5, C/O pain when walking. 4/2/09-back pain no relief. Orthopaedic evaluation 8/29/08-orthopaedic evaluation. C/O bilateral should pain began 1 week prior now low back pain and upper back pain. Migraine headaches in past. Impression: acute back pain of unlear etiology. Impression: thoracic back pain of unclear etiology. 9/5/08-worsening back pain, impression:thoracic pain with component of cervical pain. Rheumatology consult 10/2/08-impression:pain amplification.


Changed on 1/4/2011

344584 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:New York
Vaccinated:2008-07-22
Onset:2008-08-05
Submitted:2009-04-20
Entered:2009-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0072X / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Antinuclear antibody, Back pain, Blood immunoglobulin A, Blood immunoglobulin G, Blood immunoglobulin M, Blood thyroid stimulating hormone, Fatigue, Haemoglobin normal, Rheumatoid factor, Sacroiliitis, Thyroxine, White blood cell count decreased, Activities of daily living impaired, Complement factor C3, Complement factor C4, Adnexa uteri mass, Liver function test normal, DNA antibody, HLA marker study, Streptococcus identification test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: FOLIC ACID; METHOTREXATE; PREVACID; TRAUIADOL; ENBRIL
Current Illness: None
Preexisting Conditions: H/O "Burning" sensation of feet 5/19/08-records received-PMH:eczema. foot burning, foot pain in 2005 and 2006.
Allergies:
Diagnostic Lab Data: Negative HLA-B27; 9-11-08 Hg 12.5, Wbc5 100; Normal LFTS; U/A; IgG, A, ME, C3 C4; ANA; DNAA; RF ASO; Aule SSA & B; acute DNA SE, TY, TSH 5/19/09-records received-Laboratory tests normal. 9/3/08-x-rays demonstrate open growth plates of vert vertebral bodies no abnormalities detected. Sacroiliac pain and inflammation noted on MRI. HLA-B27 negative.
CDC 'Split Type':

Write-up:Since 8/5/08, 2 wks after her 2nd GARDASIL shot, this girl has had severe back pain with diagnosis of Sacroileitis, pain Amplification syndrome. Pain 7/10, fatigued. Her best friend developed severity arthritis too after vaccine recently has missed 35 d of school 2008-9 5/19/09-records received-Office note 7/22/08 SI joint inflammed, positive for strep antibody. Right complex adnexal cyst. 9/25/08-bulging L4/5, C/O pain when walking. 4/2/09-back pain no relief. Orthopaedic evaluation 8/29/08-orthopaedic evaluation. C/O bilateral should pain began 1 week prior now low back pain and upper back pain. Migraine headaches in past. Impression: acute back pain of unlear etiology. Impression: thoracic back pain of unclear etiology. 9/5/08-worsening back pain, impression:thoracic pain with component of cervical pain. Rheumatology consult 10/2/08-impression:pain amplification.


Changed on 4/13/2011

344584 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:New York
Vaccinated:2008-07-22
Onset:2008-08-05
Submitted:2009-04-20
Entered:2009-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0072X / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Antinuclear antibody, Back pain, Blood immunoglobulin A, Blood immunoglobulin G, Blood immunoglobulin M, Blood thyroid stimulating hormone, Cyst, Fatigue, Haemoglobin normal, Migraine, Neck pain, Nuclear magnetic resonance imaging abnormal, Rheumatoid factor, Sacroiliitis, Thyroxine, White blood cell count decreased, X-ray normal, Activities of daily living impaired, Complement factor C3, Complement factor C4, Adnexa uteri mass, Liver function test normal, DNA antibody, Inflammation, HLA marker study, Streptococcus identification test positive, Streptococcus identification test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: FOLIC ACID; METHOTREXATE; PREVACID; TRAUIADOL; ENBRIL
Current Illness: None
Preexisting Conditions: H/O "Burning" sensation of feet 5/19/08-records received-PMH:eczema. foot burning, foot pain in 2005 and 2006.
Allergies:
Diagnostic Lab Data: Negative HLA-B27; 9-11-08 Hg 12.5, Wbc5 100; Normal LFTS; U/A; IgG, A, ME, C3 C4; ANA; DNAA; RF ASO; Aule SSA & B; acute DNA SE, TY, TSH 5/19/09-records received-Laboratory tests normal. 9/3/08-x-rays demonstrate open growth plates of vertebral bodies no abnormalities detected. Sacroiliac pain and inflammation noted on MRI. HLA-B27 negative.
CDC 'Split Type':

Write-up:Since 8/5/08, 2 wks after her 2nd GARDASIL shot, this girl has had severe back pain with diagnosis of Sacroileitis, pain Amplification syndrome. Pain 7/10, fatigued. Her best friend developed severity arthritis too after vaccine recently has missed 35 d of school 2008-9 5/19/09-records received-Office note 7/22/08 SI joint inflammed, positive for strep antibody. Right complex adnexal cyst. 9/25/08-bulging L4/5, C/O pain when walking. 4/2/09-back pain no relief. Orthopaedic evaluation 8/29/08-orthopaedic evaluation. C/O bilateral should pain began 1 week prior now low back pain and upper back pain. Migraine headaches in past. Impression: acute back pain of unlear etiology. Impression: thoracic back pain of unclear etiology. 9/5/08-worsening back pain, impression:thoracic pain with component of cervical pain. Rheumatology consult 10/2/08-impression:pain amplification.


Changed on 5/13/2011

344584 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:New York
Vaccinated:2008-07-22
Onset:2008-08-05
Submitted:2009-04-20
Entered:2009-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0072X / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Antinuclear antibody, Back pain, Blood immunoglobulin A, Blood immunoglobulin G, Blood immunoglobulin M, Blood thyroid stimulating hormone, Cyst, Fatigue, Haemoglobin normal, Migraine, Neck pain, Nuclear magnetic resonance imaging abnormal, Rheumatoid factor, Sacroiliitis, Thyroxine, White blood cell count decreased, X-ray normal, Activities of daily living impaired, Complement factor C3, Complement factor C4, Adnexa uteri mass, Liver function test normal, DNA antibody, Inflammation, HLA marker study, Streptococcus identification test positive, Streptococcus identification test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: FOLIC ACID; METHOTREXATE; PREVACID; TRAUIADOL; ENBRIL
Current Illness: None
Preexisting Conditions: H/O "Burning" sensation of feet 5/19/08-records received-PMH:eczema. foot burning, foot pain in 2005 and 2006.
Allergies:
Diagnostic Lab Data: Negative HLA-B27; 9-11-08 Hg 12.5, Wbc5 100; Normal LFTS; U/A; IgG, A, ME, C3 C4; ANA; DNAA; RF ASO; Aule SSA & B; acute DNA SE, TY, TSH 5/19/09-records received-Laboratory tests normal. 9/3/08-x-rays demonstrate open growth plates of vertebral bodies no abnormalities detected. Sacroiliac pain and inflammation noted on MRI. HLA-B27 negative.
CDC 'Split Type':

Write-up:Since 8/5/08, 2 wks after her 2nd GARDASIL shot, this girl has had severe back pain with diagnosis of Sacroileitis, pain Amplification syndrome. Pain 7/10, fatigued. Her best friend developed severity arthritis too after vaccine recently has missed 35 d of school 2008-9 5/19/09-records received-Office note 7/22/08 SI joint inflammed, positive for strep antibody. Right complex adnexal cyst. 9/25/08-bulging L4/5, C/O pain when walking. 4/2/09-back pain no relief. Orthopaedic evaluation 8/29/08-orthopaedic evaluation. C/O bilateral should pain began 1 week prior now low back pain and upper back pain. Migraine headaches in past. Impression: acute back pain of unlear etiology. Impression: thoracic back pain of unclear etiology. 9/5/08-worsening back pain, impression:thoracic pain with component of cervical pain. Rheumatology consult 10/2/08-impression:pain amplification.


Changed on 6/11/2011

344584 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:New York
Vaccinated:2008-07-22
Onset:2008-08-05
Submitted:2009-04-20
Entered:2009-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0072X / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Antinuclear antibody, Back pain, Blood immunoglobulin A, Blood immunoglobulin G, Blood immunoglobulin M, Blood thyroid stimulating hormone, Cyst, Fatigue, Haemoglobin normal, Migraine, Neck pain, Nuclear magnetic resonance imaging abnormal, Rheumatoid factor, Sacroiliitis, Thyroxine, White blood cell count decreased, X-ray normal, Activities of daily living impaired, Complement factor C3, Complement factor C4, Adnexa uteri mass, Liver function test normal, DNA antibody, Inflammation, HLA marker study, Streptococcus identification test positive, Streptococcus identification test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: FOLIC ACID; METHOTREXATE; PREVACID; TRAUIADOL; ENBRIL
Current Illness: None
Preexisting Conditions: H/O "Burning" sensation of feet 5/19/08-records received-PMH:eczema. foot burning, foot pain in 2005 and 2006.
Allergies:
Diagnostic Lab Data: Negative HLA-B27; 9-11-08 Hg 12.5, Wbc5 100; Normal LFTS; U/A; IgG, A, ME, C3 C4; ANA; DNAA; RF ASO; Aule SSA & B; acute DNA SE, TY, TSH 5/19/09-records received-Laboratory tests normal. 9/3/08-x-rays demonstrate open growth plates of vertebral bodies no abnormalities detected. Sacroiliac pain and inflammation noted on MRI. HLA-B27 negative.
CDC 'Split Type':

Write-up:Since 8/5/08, 2 wks after her 2nd GARDASIL shot, this girl has had severe back pain with diagnosis of Sacroileitis, pain Amplification syndrome. Pain 7/10, fatigued. Her best friend developed severity arthritis too after vaccine recently has missed 35 d of school 2008-9 5/19/09-records received-Office note 7/22/08 SI joint inflammed, positive for strep antibody. Right complex adnexal cyst. 9/25/08-bulging L4/5, C/O pain when walking. 4/2/09-back pain no relief. Orthopaedic evaluation 8/29/08-orthopaedic evaluation. C/O bilateral should pain began 1 week prior now low back pain and upper back pain. Migraine headaches in past. Impression: acute back pain of unlear etiology. Impression: thoracic back pain of unclear etiology. 9/5/08-worsening back pain, impression:thoracic pain with component of cervical pain. Rheumatology consult 10/2/08-impression:pain amplification.


Changed on 6/14/2014

344584 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:New York
Vaccinated:2008-07-22
Onset:2008-08-05
Submitted:2009-04-20
Entered:2009-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0072X / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Antinuclear antibody, Back pain, Blood immunoglobulin A, Blood immunoglobulin G, Blood immunoglobulin M, Blood thyroid stimulating hormone, Cyst, Fatigue, Haemoglobin normal, Migraine, Neck pain, Nuclear magnetic resonance imaging abnormal, Rheumatoid factor, Sacroiliitis, Thyroxine, White blood cell count decreased, X-ray normal, Activities of daily living impaired, Complement factor C3, Complement factor C4, Adnexa uteri mass, Liver function test normal, DNA antibody, Inflammation, HLA marker study, Streptococcus identification test positive, Streptococcus identification test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: FOLIC ACID; METHOTREXATE; PREVACID; TRAUIADOL; ENBRIL
Current Illness: None
Preexisting Conditions: H/O "Burning" sensation of feet 5/19/08-records received-PMH:eczema. foot burning, foot pain in 2005 and 2006.
Allergies:
Diagnostic Lab Data: Negative HLA-B27; 9-11-08 Hg 12.5, Wbc5 100; Normal LFTS; U/A; IgG, A, ME, C3 C4; ANA; DNAA; RF ASO; Aule SSA & B; acute DNA SE, TY, TSH 5/19/09-records received-Laboratory tests normal. 9/3/08-x-rays demonstrate open growth plates of vertebral bodies no abnormalities detected. Sacroiliac pain and inflammation noted on MRI. HLA-B27 negative.
CDC 'Split Type':

Write-up:Since 8/5/08, 2 wks after her 2nd GARDASIL shot, this girl has had severe back pain with diagnosis of Sacroileitis, pain Amplification syndrome. Pain 7/10, fatigued. Her best friend developed severity arthritis too after vaccine recently has missed 35 d of school 2008-9 5/19/09-records received-Office note 7/22/08 SI joint inflammed, positive for strep antibody. Right complex adnexal cyst. 9/25/08-bulging L4/5, C/O pain when walking. 4/2/09-back pain no relief. Orthopaedic evaluation 8/29/08-orthopaedic evaluation. C/O bilateral should pain began 1 week prior now low back pain and upper back pain. Migraine headaches in past. Impression: acute back pain of unlear etiology. Impression: thoracic back pain of unclear etiology. 9/5/08-worsening back pain, impression:thoracic pain with component of cervical pain. Rheumatology consult 10/2/08-impression:pain amplification.


Changed on 4/14/2017

344584 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:New York
Vaccinated:2008-07-22
Onset:2008-08-05
Submitted:2009-04-20
Entered:2009-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0072X / 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Antinuclear antibody, Back pain, Blood immunoglobulin A, Blood immunoglobulin G, Blood immunoglobulin M, Blood thyroid stimulating hormone, Cyst, Fatigue, Haemoglobin normal, Migraine, Neck pain, Nuclear magnetic resonance imaging abnormal, Rheumatoid factor, Sacroiliitis, Thyroxine, White blood cell count decreased, X-ray normal, Activities of daily living impaired, Complement factor C3, Complement factor C4, Adnexa uteri mass, Liver function test normal, DNA antibody, Inflammation, HLA marker study, Streptococcus identification test positive, Streptococcus identification test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: FOLIC ACID; METHOTREXATE; PREVACID; TRAUIADOL; ENBRIL
Current Illness: None
Preexisting Conditions: H/O "Burning" sensation of feet 5/19/08-records received-PMH:eczema. foot burning, foot pain in 2005 and 2006.
Allergies:
Diagnostic Lab Data: Negative HLA-B27; 9-11-08 Hg 12.5, Wbc5 100; Normal LFTS; U/A; IgG, A, ME, C3 C4; ANA; DNAA; RF ASO; Aule SSA & B; acute DNA SE, TY, TSH 5/19/09-records received-Laboratory tests normal. 9/3/08-x-rays demonstrate open growth plates of vertebral bodies no abnormalities detected. Sacroiliac pain and inflammation noted on MRI. HLA-B27 negative.
CDC 'Split Type':

Write-up:Since 8/5/08, 2 wks after her 2nd GARDASIL shot, this girl has had severe back pain with diagnosis of Sacroileitis, pain Amplification syndrome. Pain 7/10, fatigued. Her best friend developed severity arthritis too after vaccine recently has missed 35 d of school 2008-9 5/19/09-records received-Office note 7/22/08 SI joint inflammed, positive for strep antibody. Right complex adnexal cyst. 9/25/08-bulging L4/5, C/O pain when walking. 4/2/09-back pain no relief. Orthopaedic evaluation 8/29/08-orthopaedic evaluation. C/O bilateral should pain began 1 week prior now low back pain and upper back pain. Migraine headaches in past. Impression: acute back pain of unlear etiology. Impression: thoracic back pain of unclear etiology. 9/5/08-worsening back pain, impression:thoracic pain with component of cervical pain. Rheumatology consult 10/2/08-impression:pain amplification.


Changed on 9/14/2017

344584 Before After
VAERS Form:(blank) 1
Age:14.0
Gender:Female
Location:New York
Vaccinated:2008-07-22
Onset:2008-08-05
Submitted:2009-04-20
Entered:2009-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0072X / 1 2 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain, Antinuclear antibody, Back pain, Blood immunoglobulin A, Blood immunoglobulin G, Blood immunoglobulin M, Blood thyroid stimulating hormone, Fatigue, Haemoglobin normal, Rheumatoid factor, Sacroiliitis, Thyroxine, White blood cell count decreased, Activities of daily living impaired, Complement factor C3, Complement factor C4, Liver function test normal, DNA antibody, HLA marker study, Streptococcus identification test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: FOLIC ACID; METHOTREXATE; PREVACID; TRAUIADOL; ENBRIL
Current Illness: None
Preexisting Conditions: H/O "Burning" sensation of feet 5/19/08-records received-PMH:eczema. foot burning, foot pain in 2005 and 2006.
Allergies:
Diagnostic Lab Data: Negative HLA-B27; 9-11-08 Hg 12.5, Wbc5 100; Normal LFTS; U/A; IgG, A, ME, C3 C4; ANA; DNAA; RF ASO; Aule SSA & B; acute DNA SE, TY, TSH 5/19/09-records received-Laboratory tests normal. 9/3/08-x-rays demonstrate open growth plates of vertebral bodies no abnormalities detected. Sacroiliac pain and inflammation noted on MRI. HLA-B27 negative.
CDC 'Split Type':

Write-up:Since 8/5/08, 2 wks after her 2nd GARDASIL shot, this girl has had severe back pain with diagnosis of Sacroileitis, pain Amplification syndrome. Pain 7/10, fatigued. Her best friend developed severity arthritis too after vaccine recently has missed 35 d of school 2008-9 5/19/09-records received-Office note 7/22/08 SI joint inflammed, positive for strep antibody. Right complex adnexal cyst. 9/25/08-bulging L4/5, C/O pain when walking. 4/2/09-back pain no relief. Orthopaedic evaluation 8/29/08-orthopaedic evaluation. C/O bilateral should pain began 1 week prior now low back pain and upper back pain. Migraine headaches in past. Impression: acute back pain of unlear etiology. Impression: thoracic back pain of unclear etiology. 9/5/08-worsening back pain, impression:thoracic pain with component of cervical pain. Rheumatology consult 10/2/08-impression:pain amplification.


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