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This is VAERS ID 358667

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

358667
VAERS Form:
Age:16.0
Gender:Female
Location:North Carolina
Vaccinated:2009-06-30
Onset:2009-09-14
Submitted:2009-09-28
Entered:2009-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Abdominal pain upper, Computerised tomogram normal, Nuclear magnetic resonance imaging normal, Blood test normal, Epstein-Barr virus test positive

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Diagnostic laboratory, 09/19/09, Blood work was normal; Computed axial, 09/19/09, normal; Magnetic resonance, 09/19/09, abdominal: normal; Serum Epstein-Barr, 09/19?/09, positive
CDC 'Split Type': WAES0909USA03143

Write-up:Information has been received from a physician concerning his 16 year old daughter with no pertinent medical history and no known drug allergies who on 30-JUN-2009 was vaccinated IM with a first 0.5ml dose of GARDASIL (lot# not reported). There was no concomitant medication. On 14-SEP-2009 the patient experienced severe, crampy, intermittent left upper abdominal quadrant pain. On 19-SEP-2009 the patient was admitted to hospital. Blood work, computed axial tomography (CT) scan, and abdominal magnetic resonance imaging (MRI) were normal. The test results on the patient came back as positive for Epstein Barr virus. The patient received pain management with hydrocodone and intravenous morphine. The patient was discharged on 20-SEP-2009. At the time of the report, the patient had not recovered. Severe, crampy, intermittent left upper abdominal quadrant pain and positive for epstein barr virus were considered to be disabling. Additional information has been requested.


Changed on 9/14/2017

358667 Before After
VAERS Form:(blank) 1
Age:16.0
Gender:Female
Location:North Carolina
Vaccinated:2009-06-30
Onset:2009-09-14
Submitted:2009-09-28
Entered:2009-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 1 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Abdominal pain upper, Computerised tomogram normal, Nuclear magnetic resonance imaging normal, Blood test normal, Epstein-Barr virus test positive

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Diagnostic laboratory, 09/19/09, Blood work was normal; Computed axial, 09/19/09, normal; Magnetic resonance, 09/19/09, abdominal: normal; Serum Epstein-Barr, 09/19?/09, positive
CDC 'Split Type': WAES0909USA03143

Write-up:Information has been received from a physician concerning his 16 year old daughter with no pertinent medical history and no known drug allergies who on 30-JUN-2009 was vaccinated IM with a first 0.5ml dose of GARDASIL (lot# not reported). There was no concomitant medication. On 14-SEP-2009 the patient experienced severe, crampy, intermittent left upper abdominal quadrant pain. On 19-SEP-2009 the patient was admitted to hospital. Blood work, computed axial tomography (CT) scan, and abdominal magnetic resonance imaging (MRI) were normal. The test results on the patient came back as positive for Epstein Barr virus. The patient received pain management with hydrocodone and intravenous morphine. The patient was discharged on 20-SEP-2009. At the time of the report, the patient had not recovered. Severe, crampy, intermittent left upper abdominal quadrant pain and positive for epstein barr virus were considered to be disabling. Additional information has been requested.


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