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This is VAERS ID 346052

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

346052
VAERS Form:
Age:13.0
Gender:Female
Location:North Carolina
Vaccinated:2008-09-26
Onset:0000-00-00
Submitted:2009-05-08
Entered:2009-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB294BA / 1 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0843X / 2 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Arthralgia, Barium swallow normal, Blood immunoglobulin G normal, Blood thyroid stimulating hormone, C-reactive protein increased, Carbon dioxide increased, Chest pain, Chest X-ray normal, Chronic fatigue syndrome, Computerised tomogram normal, Decreased activity, Dizziness, Dyspnoea, Echocardiogram normal, Electrocardiogram normal, Electroencephalogram normal, Fall, Fatigue, Full blood count normal, Head injury, Headache, Injury, Loss of consciousness, Myalgia, Mydriasis, Nausea, Nuclear magnetic resonance imaging brain normal, Orthostatic hypotension, Pain, Pyrexia, Sleep disorder, Snoring, Syncope, Thyroxine, Unresponsive to stimuli, Urinary system X-ray, Weight increased, X-ray normal, Bedridden, Red blood cell sedimentation rate increased, Activities of daily living impaired, Musculoskeletal stiffness, Sleep study normal, Gastric disorder, Abdominal X-ray, Metabolic function test normal, Mycoplasma serology positive, Epstein-Barr virus 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: AMITRIPTYLIN mg; ibuprofen 6/1/09 Neurology consultation records received DOS 4/14/09. albuterol, amitriptylin.
Current Illness:
Preexisting Conditions: None 5/18/09 PCP med records HPV #1 given 3/13/08, Lot # 1757U, IM/RA; Hep A #1 given 3/13/08, Lot # AHAVB225BB, IM LA. HPV #2 given 5/23/08, Lot # 0063X, IM/LA. 6/1/09 Neurology consultation records received DOS 4/14/09. Otitis media, hearing loss, PE tubes, adenoids removed, cyst on neck. Hospitalized for dehydration. Rash. Learning disability. 7/17/09 Pediatric infectious
Allergies:
Diagnostic Lab Data: Unknown 5/18/09 PCP medical records LABS: CBC, CMP, TSH, T4, EBV, monospot, IgG all WNL. BE swallow, abd x-ray, KUB, CT head, MRI brain, EEG all WNL. 6/1/09 Neurology consultation records received DOS 4/14/09. LABS and DIAGNOSTICS: E
CDC 'Split Type': WAES0905USA00372

Write-up:Initial and follow-up information has been received from a consumer concerning a 13 year old female with no pertinent medical history and no drug reactions/allergies who on 13-MAR-2008, 23-MAY-2008 and 26-SEP-2008 was vaccinated with the first, second and third dose of GARDASIL respectively (lot # 659182/1757U, 660391/0063X and 659184/0843X), injection. Concomitant therapy included ibuprofen and AMITRIPTYLIN. In September 2008, the mother stated her daughter experienced chest pain, fever, nausea, muscle stiffness, headaches, stomach problem, and when she was not really feeling well in her pupils became "dilated", while on GARDASIL. She did not go to school and was not active because she could not even get out of bed. The patient had had chest X-rays, EEG''S, CAT Scans, sleep studies, and blood work done which all came back negative. The consumer also reported that the patient was an avid dancer before getting GARDASIL and she could not even get out of bed, "I had taken her to specialist and other physicians and no one can figure out what is wrong". The patient''s outcome was not recovered. On unspecified date, the patient sought unspecified medical attention. The nurse stated that the patient''s mother consented to come to the office to sign the Consent for the Release of Medical Information concerning the patient, and she would call back when the patient''s mother signed the Consent Form about if the patient was able to attend school. Upon internal review she doesn''t go to school and isn''t active because she can''t even get out of bed was considered to be disabling. This is one of several reports concerning the same source. A lot check has been initiated. Additional information has been requested. 5/18/09 Received vaccine & PCP office records of 2/20-3/23/2009. FINAL DX: fatigue syndrome Records reveal patient w/intermittent low grade fever, fatigue, HA, abd pain, chest pain since approx 9/08. No longer able to participate in dance & missed some days of school. Referred to Neuro, Cardio & ID. Seen in ER for p


Changed on 8/31/2010

346052 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:North Carolina
Vaccinated:2008-09-26
Onset:0000-00-00
Submitted:2009-05-08
Entered:2009-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB294BA / 1 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0843X / 2 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Arthralgia, Barium swallow normal, Blood immunoglobulin G normal, Blood thyroid stimulating hormone, C-reactive protein increased, Carbon dioxide increased, Chest pain, Chest X-ray normal, Chronic fatigue syndrome, Computerised tomogram normal, Decreased activity, Dizziness, Dyspnoea, Echocardiogram normal, Electrocardiogram normal, Electroencephalogram normal, Fall, Fatigue, Full blood count normal, Head injury, Headache, Injury, Loss of consciousness, Myalgia, Mydriasis, Nausea, Nuclear magnetic resonance imaging brain normal, Orthostatic hypotension, Pain, Pyrexia, Sleep disorder, Snoring, Syncope, Thyroxine, Unresponsive to stimuli, Urinary system X-ray, Weight increased, X-ray normal, Bedridden, Red blood cell sedimentation rate increased, Activities of daily living impaired, Musculoskeletal stiffness, Sleep study normal, Gastric disorder, Abdominal X-ray, Metabolic function test normal, Mycoplasma serology positive, Epstein-Barr virus 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: AMITRIPTYLIN mg; ibuprofen 6/1/09 Neurology consultation records received DOS 4/14/09. albuterol, amitriptylin.
Current Illness:
Preexisting Conditions: None 5/18/09 PCP med records HPV #1 given 3/13/08, Lot # 1757U, IM/RA; Hep A #1 given 3/13/08, Lot # AHAVB225BB, IM LA. HPV #2 given 5/23/08, Lot # 0063X, IM/LA. 6/1/09 Neurology consultation records received DOS 4/14/09. Otitis media, hearing loss, PE tubes, adenoids removed, cyst on neck. Hospitalized for dehydration. Rash. Learning disability. 7/17/09 Pediatric infectious
Allergies:
Diagnostic Lab Data: Unknown 5/18/09 PCP medical records LABS: CBC, CMP, TSH, T4, EBV, monospot, IgG all WNL. BE swallow, abd x-ray, KUB, CT head, MRI brain, EEG all WNL. 6/1/09 Neurology consultation records received DOS 4/14/09. LABS and DIAGNOSTICS: E
CDC 'Split Type': WAES0905USA00372

Write-up:Initial and follow-up information has been received from a consumer concerning a 13 year old female with no pertinent medical history and no drug reactions/allergies who on 13-MAR-2008, 23-MAY-2008 and 26-SEP-2008 was vaccinated with the first, second and third dose of GARDASIL respectively (lot # 659182/1757U, 660391/0063X and 659184/0843X), injection. Concomitant therapy included ibuprofen and AMITRIPTYLIN. In September 2008, the mother stated her daughter experienced chest pain, fever, nausea, muscle stiffness, headaches, stomach problem, and when she was not really feeling well in her pupils became "dilated", while on GARDASIL. She did not go to school and was not active because she could not even get out of bed. The patient had had chest X-rays, EEG''S, CAT Scans, sleep studies, and blood work done which all came back negative. The consumer also reported that the patient was an avid dancer before getting GARDASIL and she could not even get out of bed, "I had taken her to specialist and other physicians and no one can figure out what is wrong". The patient''s outcome was not recovered. On unspecified date, the patient sought unspecified medical attention. The nurse stated that the patient''s mother consented to come to the office to sign the Consent for the Release of Medical Information concerning the patient, and she would call back when the patient''s mother signed the Consent Form about if the patient was able to attend school. Upon internal review she doesn''t go to school and isn''t active because she can''t even get out of bed was considered to be disabling. This is one of several reports concerning the same source. A lot check has been initiated. Additional information has been requested. 5/18/09 Received vaccine & PCP office records of 2/20-3/23/2009. FINAL DX: fatigue syndrome Records reveal patient w/intermittent low grade fever, fatigue, HA, abd pain, chest pain since approx 9/08. No longer able to participate in dance & missed some days of school. Referred to Neuro, Cardio & ID. Seen in ER for p


Changed on 4/13/2011

346052 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:North Carolina
Vaccinated:2008-09-26
Onset:0000-00-00
Submitted:2009-05-08
Entered:2009-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB294BA / 1 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0843X / 2 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Arthralgia, Barium swallow normal, Blood immunoglobulin G normal, Blood thyroid stimulating hormone, C-reactive protein increased, Carbon dioxide increased, Chest pain, Chest X-ray normal, Chronic fatigue syndrome, Computerised tomogram normal, Decreased activity, Dizziness, Dyspnoea, Echocardiogram normal, Electrocardiogram normal, Electroencephalogram normal, Fall, Fatigue, Full blood count normal, Head injury, Headache, Injury, Loss of consciousness, Myalgia, Mydriasis, Nausea, Nuclear magnetic resonance imaging brain normal, Orthostatic hypotension, Pain, Pyrexia, Sleep disorder, Snoring, Syncope, Thyroxine, Unresponsive to stimuli, Urinary system X-ray, Weight increased, X-ray normal, Bedridden, Red blood cell sedimentation rate increased, Activities of daily living impaired, Musculoskeletal stiffness, Sleep study normal, Gastric disorder, Abdominal X-ray, Metabolic function test normal, Mycoplasma serology positive, Epstein-Barr virus 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: AMITRIPTYLIN mg; ibuprofen 6/1/09 Neurology consultation records received DOS 4/14/09. albuterol, amitriptylin.
Current Illness:
Preexisting Conditions: None 5/18/09 PCP med records HPV #1 given 3/13/08, Lot # 1757U, IM/RA; Hep A #1 given 3/13/08, Lot # AHAVB225BB, IM LA. HPV #2 given 5/23/08, Lot # 0063X, IM/LA. 6/1/09 Neurology consultation records received DOS 4/14/09. Otitis media, hearing loss, PE tubes, adenoids removed, cyst on neck. Hospitalized for dehydration. Rash. Learning disability. 7/17/09 Pediatric infectious
Allergies:
Diagnostic Lab Data: Unknown 5/18/09 PCP medical records LABS: CBC, CMP, TSH, T4, EBV, monospot, IgG all WNL. BE swallow, abd x-ray, KUB, CT head, MRI brain, EEG all WNL. 6/1/09 Neurology consultation records received DOS 4/14/09. LABS and DIAGNOSTICS: E
CDC 'Split Type': WAES0905USA00372

Write-up:Initial and follow-up information has been received from a consumer concerning a 13 year old female with no pertinent medical history and no drug reactions/allergies who on 13-MAR-2008, 23-MAY-2008 and 26-SEP-2008 was vaccinated with the first, second and third dose of GARDASIL respectively (lot # 659182/1757U, 660391/0063X and 659184/0843X), injection. Concomitant therapy included ibuprofen and AMITRIPTYLIN. In September 2008, the mother stated her daughter experienced chest pain, fever, nausea, muscle stiffness, headaches, stomach problem, and when she was not really feeling well in her pupils became "dilated", while on GARDASIL. She did not go to school and was not active because she could not even get out of bed. The patient had had chest X-rays, EEG''S, CAT Scans, sleep studies, and blood work done which all came back negative. The consumer also reported that the patient was an avid dancer before getting GARDASIL and she could not even get out of bed, "I had taken her to specialist and other physicians and no one can figure out what is wrong". The patient''s outcome was not recovered. On unspecified date, the patient sought unspecified medical attention. The nurse stated that the patient''s mother consented to come to the office to sign the Consent for the Release of Medical Information concerning the patient, and she would call back when the patient''s mother signed the Consent Form about if the patient was able to attend school. Upon internal review she doesn''t go to school and isn''t active because she can''t even get out of bed was considered to be disabling. This is one of several reports concerning the same source. A lot check has been initiated. Additional information has been requested. 5/18/09 Received vaccine & PCP office records of 2/20-3/23/2009. FINAL DX: fatigue syndrome Records reveal patient w/intermittent low grade fever, fatigue, HA, abd pain, chest pain since approx 9/08. No longer able to participate in dance & missed some days of school. Referred to Neuro, Cardio & ID. Seen in ER for p


Changed on 5/13/2011

346052 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:North Carolina
Vaccinated:2008-09-26
Onset:0000-00-00
Submitted:2009-05-08
Entered:2009-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB294BA / 1 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0843X / 2 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Arthralgia, Barium swallow normal, Blood immunoglobulin G normal, Blood thyroid stimulating hormone, C-reactive protein increased, Carbon dioxide increased, Chest pain, Chest X-ray normal, Chronic fatigue syndrome, Computerised tomogram normal, Decreased activity, Dizziness, Dyspnoea, Echocardiogram normal, Electrocardiogram normal, Electroencephalogram normal, Fall, Fatigue, Full blood count normal, Head injury, Headache, Injury, Loss of consciousness, Myalgia, Mydriasis, Nausea, Nuclear magnetic resonance imaging brain normal, Orthostatic hypotension, Pain, Pyrexia, Sleep disorder, Snoring, Syncope, Thyroxine, Unresponsive to stimuli, Urinary system X-ray, Weight increased, X-ray normal, Bedridden, Red blood cell sedimentation rate increased, Activities of daily living impaired, Musculoskeletal stiffness, Sleep study normal, Gastric disorder, Abdominal X-ray, Metabolic function test normal, Mycoplasma serology positive, Epstein-Barr virus 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: AMITRIPTYLIN mg; ibuprofen 6/1/09 Neurology consultation records received DOS 4/14/09. albuterol, amitriptylin.
Current Illness:
Preexisting Conditions: None 5/18/09 PCP med records HPV #1 given 3/13/08, Lot # 1757U, IM/RA; Hep A #1 given 3/13/08, Lot # AHAVB225BB, IM LA. HPV #2 given 5/23/08, Lot # 0063X, IM/LA. 6/1/09 Neurology consultation records received DOS 4/14/09. Otitis media, hearing loss, PE tubes, adenoids removed, cyst on neck. Hospitalized for dehydration. Rash. Learning disability. 7/17/09 Pediatric infectious
Allergies:
Diagnostic Lab Data: Unknown 5/18/09 PCP medical records LABS: CBC, CMP, TSH, T4, EBV, monospot, IgG all WNL. BE swallow, abd x-ray, KUB, CT head, MRI brain, EEG all WNL. 6/1/09 Neurology consultation records received DOS 4/14/09. LABS and DIAGNOSTICS: E
CDC 'Split Type': WAES0905USA00372

Write-up:Initial and follow-up information has been received from a consumer concerning a 13 year old female with no pertinent medical history and no drug reactions/allergies who on 13-MAR-2008, 23-MAY-2008 and 26-SEP-2008 was vaccinated with the first, second and third dose of GARDASIL respectively (lot # 659182/1757U, 660391/0063X and 659184/0843X), injection. Concomitant therapy included ibuprofen and AMITRIPTYLIN. In September 2008, the mother stated her daughter experienced chest pain, fever, nausea, muscle stiffness, headaches, stomach problem, and when she was not really feeling well in her pupils became "dilated", while on GARDASIL. She did not go to school and was not active because she could not even get out of bed. The patient had had chest X-rays, EEG''S, CAT Scans, sleep studies, and blood work done which all came back negative. The consumer also reported that the patient was an avid dancer before getting GARDASIL and she could not even get out of bed, "I had taken her to specialist and other physicians and no one can figure out what is wrong". The patient''s outcome was not recovered. On unspecified date, the patient sought unspecified medical attention. The nurse stated that the patient''s mother consented to come to the office to sign the Consent for the Release of Medical Information concerning the patient, and she would call back when the patient''s mother signed the Consent Form about if the patient was able to attend school. Upon internal review she doesn''t go to school and isn''t active because she can''t even get out of bed was considered to be disabling. This is one of several reports concerning the same source. A lot check has been initiated. Additional information has been requested. 5/18/09 Received vaccine & PCP office records of 2/20-3/23/2009. FINAL DX: fatigue syndrome Records reveal patient w/intermittent low grade fever, fatigue, HA, abd pain, chest pain since approx 9/08. No longer able to participate in dance & missed some days of school. Referred to Neuro, Cardio & ID. Seen in ER for p


Changed on 6/11/2011

346052 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:North Carolina
Vaccinated:2008-09-26
Onset:0000-00-00
Submitted:2009-05-08
Entered:2009-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB294BA / 1 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0843X / 2 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Arthralgia, Barium swallow normal, Blood immunoglobulin G normal, Blood thyroid stimulating hormone, C-reactive protein increased, Carbon dioxide increased, Chest pain, Chest X-ray normal, Chronic fatigue syndrome, Computerised tomogram normal, Decreased activity, Dizziness, Dyspnoea, Echocardiogram normal, Electrocardiogram normal, Electroencephalogram normal, Fall, Fatigue, Full blood count normal, Head injury, Headache, Injury, Loss of consciousness, Myalgia, Mydriasis, Nausea, Nuclear magnetic resonance imaging brain normal, Orthostatic hypotension, Pain, Pyrexia, Sleep disorder, Snoring, Syncope, Thyroxine, Unresponsive to stimuli, Urinary system X-ray, Weight increased, X-ray normal, Bedridden, Red blood cell sedimentation rate increased, Activities of daily living impaired, Musculoskeletal stiffness, Sleep study normal, Gastric disorder, Abdominal X-ray, Metabolic function test normal, Mycoplasma serology positive, Epstein-Barr virus 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: AMITRIPTYLIN mg; ibuprofen 6/1/09 Neurology consultation records received DOS 4/14/09. albuterol, amitriptylin.
Current Illness:
Preexisting Conditions: None 5/18/09 PCP med records HPV #1 given 3/13/08, Lot # 1757U, IM/RA; Hep A #1 given 3/13/08, Lot # AHAVB225BB, IM LA. HPV #2 given 5/23/08, Lot # 0063X, IM/LA. 6/1/09 Neurology consultation records received DOS 4/14/09. Otitis media, hearing loss, PE tubes, adenoids removed, cyst on neck. Hospitalized for dehydration. Rash. Learning disability. 7/17/09 Pediatric infectious
Allergies:
Diagnostic Lab Data: Unknown 5/18/09 PCP medical records LABS: CBC, CMP, TSH, T4, EBV, monospot, IgG all WNL. BE swallow, abd x-ray, KUB, CT head, MRI brain, EEG all WNL. 6/1/09 Neurology consultation records received DOS 4/14/09. LABS and DIAGNOSTICS: E
CDC 'Split Type': WAES0905USA00372

Write-up:Initial and follow-up information has been received from a consumer concerning a 13 year old female with no pertinent medical history and no drug reactions/allergies who on 13-MAR-2008, 23-MAY-2008 and 26-SEP-2008 was vaccinated with the first, second and third dose of GARDASIL respectively (lot # 659182/1757U, 660391/0063X and 659184/0843X), injection. Concomitant therapy included ibuprofen and AMITRIPTYLIN. In September 2008, the mother stated her daughter experienced chest pain, fever, nausea, muscle stiffness, headaches, stomach problem, and when she was not really feeling well in her pupils became "dilated", while on GARDASIL. She did not go to school and was not active because she could not even get out of bed. The patient had had chest X-rays, EEG''S, CAT Scans, sleep studies, and blood work done which all came back negative. The consumer also reported that the patient was an avid dancer before getting GARDASIL and she could not even get out of bed, "I had taken her to specialist and other physicians and no one can figure out what is wrong". The patient''s outcome was not recovered. On unspecified date, the patient sought unspecified medical attention. The nurse stated that the patient''s mother consented to come to the office to sign the Consent for the Release of Medical Information concerning the patient, and she would call back when the patient''s mother signed the Consent Form about if the patient was able to attend school. Upon internal review she doesn''t go to school and isn''t active because she can''t even get out of bed was considered to be disabling. This is one of several reports concerning the same source. A lot check has been initiated. Additional information has been requested. 5/18/09 Received vaccine & PCP office records of 2/20-3/23/2009. FINAL DX: fatigue syndrome Records reveal patient w/intermittent low grade fever, fatigue, HA, abd pain, chest pain since approx 9/08. No longer able to participate in dance & missed some days of school. Referred to Neuro, Cardio & ID. Seen in ER for p


Changed on 4/14/2017

346052 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:North Carolina
Vaccinated:2008-09-26
Onset:0000-00-00
Submitted:2009-05-08
Entered:2009-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB294BA / 1 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0843X / 2 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Arthralgia, Barium swallow normal, Blood immunoglobulin G normal, Blood thyroid stimulating hormone, C-reactive protein increased, Carbon dioxide increased, Chest pain, Chest X-ray normal, Chronic fatigue syndrome, Computerised tomogram normal, Decreased activity, Dizziness, Dyspnoea, Echocardiogram normal, Electrocardiogram normal, Electroencephalogram normal, Fall, Fatigue, Full blood count normal, Head injury, Headache, Injury, Loss of consciousness, Myalgia, Mydriasis, Nausea, Nuclear magnetic resonance imaging brain normal, Orthostatic hypotension, Pain, Pyrexia, Sleep disorder, Snoring, Syncope, Thyroxine, Unresponsive to stimuli, Urinary system X-ray, Weight increased, X-ray normal, Bedridden, Red blood cell sedimentation rate increased, Activities of daily living impaired, Musculoskeletal stiffness, Sleep study normal, Gastric disorder, Abdominal X-ray, Metabolic function test normal, Mycoplasma serology positive, Epstein-Barr virus 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: AMITRIPTYLIN mg; ibuprofen 6/1/09 Neurology consultation records received DOS 4/14/09. albuterol, amitriptylin.
Current Illness:
Preexisting Conditions: None 5/18/09 PCP med records HPV #1 given 3/13/08, Lot # 1757U, IM/RA; Hep A #1 given 3/13/08, Lot # AHAVB225BB, IM LA. HPV #2 given 5/23/08, Lot # 0063X, IM/LA. 6/1/09 Neurology consultation records received DOS 4/14/09. Otitis media, hearing loss, PE tubes, adenoids removed, cyst on neck. Hospitalized for dehydration. Rash. Learning disability. 7/17/09 Pediatric infectious disease consultant records received DOS 6/25/09. PMH: Vomiting and diarrhea, otitis media, Cyst on neck, maculopapular rash on right ear and face, asthma.
Allergies:
Diagnostic Lab Data: Unknown 5/18/09 PCP medical records LABS: CBC, CMP, TSH, T4, EBV, monospot, IgG all WNL. BE swallow, abd x-ray, KUB, CT head, WNL[[address]]head, MRI brain, EEG all WNL. 6/1/09 Neurology consultation records received DOS 4/14/09. LABS and DIAGNOSTICS: E EEG WNL. EKG and ECHO WNL. MRI and CT WNL. 7/17/09 Pediatric infectious disease consultant records received DOS 6/25/09. LABS and DIAGNOSTICS: Elevated Mycoplasma IgG. CT Head - WNL. CMP - CO2 31 mmol/L (H). C-Reactive Protein 0.21 mg/dL (H). Sedimentation Rate 26 MM@1HR (H).
CDC 'Split Type': WAES0905USA00372

Write-up:Initial and follow-up information has been received from a consumer concerning a 13 year old female with no pertinent medical history and no drug reactions/allergies who on 13-MAR-2008, 23-MAY-2008 and 26-SEP-2008 was vaccinated with the first, second and third dose of GARDASIL respectively (lot # 659182/1757U, 660391/0063X and 659184/0843X), injection. Concomitant therapy included ibuprofen and AMITRIPTYLIN. In September 2008, the mother stated her daughter experienced chest pain, fever, nausea, muscle stiffness, headaches, stomach problem, and when she was not really feeling well in her pupils became "dilated", while on GARDASIL. She did not go to school and was not active because she could not even get out of bed. The patient had had chest X-rays, EEG''S, CAT Scans, sleep studies, and blood work done which all came back negative. The consumer also reported that the patient was an avid dancer before getting GARDASIL and she could not even get out of bed, "I had taken her to specialist and other physicians and no one can figure out what is wrong". The patient''s outcome was not recovered. On unspecified date, the patient sought unspecified medical attention. The nurse stated that the patient''s mother consented to come to the office to sign the Consent for the Release of Medical Information concerning the patient, and she would call back when the patient''s mother signed the Consent Form about if the patient was able to attend school. Upon internal review she doesn''t go to school and isn''t active because she can''t even get out of bed was considered to be disabling. This is one of several reports concerning the same source. A lot check has been initiated. Additional information has been requested. 5/18/09 Received vaccine & PCP office records of 2/20-3/23/2009. FINAL DX: fatigue syndrome Records reveal patient w/intermittent low grade fever, fatigue, HA, abd pain, chest pain since approx 9/08. No longer able to participate in dance & missed some days of school. Referred to Neuro, Cardio & ID. Seen in ER for p passing out. 6/1/09 Neurology consultation records received DOS 4/14/09. FINAL DIAGNOSIS: None provided. Post vaccination: Fevers, injuries, fatigue, headache, migratory aches and pains. Stomach pains, chest pain. Episodes of syncope, fell and hit head on the floor. Dizziness, short of breath, disturbed sleep, snores. Polysomnogram, 24 hour EEG to be performed. Immunology or infectious disease consult recommended. 7/17/09 Pediatric infectious disease consultant records received DOS 6/25/09. Assessment: Symptoms most likely related to Rheumatological condition. Patient presents with intermittent fever, fatigue, chest pain, abdominal pain, headache and myalgia since Sept. ''08 and fainting since March ''09. Myalgia of arms and legs. Knee pain. Postural hypotension. Unresponsive during fainting spells. Weight gain.


Changed on 9/14/2017

346052 Before After
VAERS Form:(blank) 1
Age:13.0
Gender:Female
Location:North Carolina
Vaccinated:2008-09-26
Onset:0000-00-00
Submitted:2009-05-08
Entered:2009-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM AHAVB294BA / 1 2 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0843X / 2 3 LA / IM

Administered by: Other      Purchased by: Other
Symptoms: Chest pain, Decreased activity, Headache, Mydriasis, Nausea, Pyrexia, Bedridden, Activities of daily living impaired, Musculoskeletal stiffness, Gastric disorder

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: AMITRIPTYLIN mg; ibuprofen 6/1/09 Neurology consultation records received DOS 4/14/09. albuterol, amitriptylin.
Current Illness:
Preexisting Conditions: None 5/18/09 PCP med records HPV #1 given 3/13/08, Lot # 1757U, IM/RA; Hep A #1 given 3/13/08, Lot # AHAVB225BB, IM LA. HPV #2 given 5/23/08, Lot # 0063X, IM/LA. 6/1/09 Neurology consultation records received DOS 4/14/09. Otitis media, hearing loss, PE tubes, adenoids removed, cyst on neck. Hospitalized for dehydration. Rash. Learning disability. 7/17/09 Pediatric infectious disease consultant records received DOS 6/25/09. PMH: Vomiting and diarrhea, otitis media, Cyst on neck, maculopapular rash on right ear and face, asthma.
Allergies:
Diagnostic Lab Data: Unknown 5/18/09 PCP medical records LABS: CBC, CMP, TSH, T4, EBV, monospot, IgG all WNL[[address]]head, MRI brain, EEG all WNL. 6/1/09 Neurology consultation records received DOS 4/14/09. LABS and DIAGNOSTICS: EEG WNL. EKG and ECHO WNL. MRI and CT WNL. 7/17/09 Pediatric infectious disease consultant records received DOS 6/25/09. LABS and DIAGNOSTICS: Elevated Mycoplasma IgG. CT Head - WNL. CMP - CO2 31 mmol/L (H). C-Reactive Protein 0.21 mg/dL (H). Sedimentation Rate 26 MM@1HR (H).
CDC 'Split Type': WAES0905USA00372

Write-up:Initial and follow-up information has been received from a consumer concerning a 13 year old female with no pertinent medical history and no drug reactions/allergies who on 13-MAR-2008, 23-MAY-2008 and 26-SEP-2008 was vaccinated with the first, second and third dose of GARDASIL respectively (lot # 659182/1757U, 660391/0063X and 659184/0843X), injection. Concomitant therapy included ibuprofen and AMITRIPTYLIN. In September 2008, the mother stated her daughter experienced chest pain, fever, nausea, muscle stiffness, headaches, stomach problem, and when she was not really feeling well in her pupils became "dilated", while on GARDASIL. She did not go to school and was not active because she could not even get out of bed. The patient had had chest X-rays, EEG''S, CAT Scans, sleep studies, and blood work done which all came back negative. The consumer also reported that the patient was an avid dancer before getting GARDASIL and she could not even get out of bed, "I had taken her to specialist and other physicians and no one can figure out what is wrong". The patient''s outcome was not recovered. On unspecified date, the patient sought unspecified medical attention. The nurse stated that the patient''s mother consented to come to the office to sign the Consent for the Release of Medical Information concerning the patient, and she would call back when the patient''s mother signed the Consent Form about if the patient was able to attend school. Upon internal review she doesn''t go to school and isn''t active because she can''t even get out of bed was considered to be disabling. This is one of several reports concerning the same source. A lot check has been initiated. Additional information has been requested. 5/18/09 Received vaccine & PCP office records of 2/20-3/23/2009. FINAL DX: fatigue syndrome Records reveal patient w/intermittent low grade fever, fatigue, HA, abd pain, chest pain since approx 9/08. No longer able to participate in dance & missed some days of school. Referred to Neuro, Cardio & ID. Seen in ER for passing out. 6/1/09 Neurology consultation records received DOS 4/14/09. FINAL DIAGNOSIS: None provided. Post vaccination: Fevers, injuries, fatigue, headache, migratory aches and pains. Stomach pains, chest pain. Episodes of syncope, fell and hit head on the floor. Dizziness, short of breath, disturbed sleep, snores. Polysomnogram, 24 hour EEG to be performed. Immunology or infectious disease consult recommended. 7/17/09 Pediatric infectious disease consultant records received DOS 6/25/09. Assessment: Symptoms most likely related to Rheumatological condition. Patient presents with intermittent fever, fatigue, chest pain, abdominal pain, headache and myalgia since Sept. ''08 and fainting since March ''09. Myalgia of arms and legs. Knee pain. Postural hypotension. Unresponsive during fainting spells. Weight gain.


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