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This is VAERS ID 358916

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 358916
VAERS Form:
Age:11.0
Gender:Female
Location:New York
Vaccinated:2008-04-07
Onset:2009-06-03
Submitted:2009-09-30
Entered:2009-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. UNK / 0 RA / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Pollakiuria, Blood test, Type 1 diabetes mellitus

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: nothing
Current Illness: none - vaccination was given at regular 11 yr old well child care check up
Preexisting Conditions: allergic to sulfar medications
Allergies:
Diagnostic Lab Data: blood tests
CDC 'Split Type':

Write-up: Diagnosed with Type 1 diabetes two months later. Frequent urination started 6 wks after vaccination and diagnosed with diabetes 8 wks after vaccination.


Changed on 1/5/2010

VAERS ID: 358916 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:New York
Vaccinated:2008-04-07
Onset:2009-06-03
Submitted:2009-09-30
Entered:2009-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB256BA / 1 RA / IJ
HPV4: HPV (GARDASIL) / MERCK & CO. INC. UNK 19878U / 0 1 RA LA / UN IJ

Administered by: Private Unknown      Purchased by: Unknown
Symptoms: Pollakiuria, Blood test, Type 1 diabetes mellitus

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 No, days: 1 (blank)     Extended hospital stay? No
Previous Vaccinations:
Other Medications: nothing
Current Illness: none - vaccination was given at regular 11 yr old well child care check up
Preexisting Conditions: allergic to sulfar sulfa medications PMH: Diabetes , scoliosis Allergies: Sulfa
Allergies:
Diagnostic Lab Data: blood tests
CDC 'Split Type':

Write-up: Diagnosed with Type 1 diabetes two months later. Frequent urination started 6 wks after vaccination and diagnosed with diabetes 8 wks after vaccination. 1/7/2010 PCP records for 2 wellness visits, 4/2008 and 5/2009, on second visit it states patient on an Insulin pump x 2 months, stable HgbA1C, Dx IDDM


Changed on 4/13/2011

VAERS ID: 358916 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:New York
Vaccinated:2008-04-07
Onset:2009-06-03
Submitted:2009-09-30
Entered:2009-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB256BA / 1 RA / IJ
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 19878U / 1 LA / IJ

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pollakiuria, Blood test, Type 1 diabetes mellitus

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: nothing
Current Illness: none - vaccination was given at regular 11 yr old well child care check up
Preexisting Conditions: allergic to sulfa medications PMH: Diabetes , scoliosis Allergies: Sulfa
Allergies:
Diagnostic Lab Data: blood tests
CDC 'Split Type':

Write-up: Diagnosed with Type 1 diabetes two months later. Frequent urination started 6 wks after vaccination and diagnosed with diabetes 8 wks after vaccination. 1/7/2010 PCP records for 2 wellness visits, 4/2008 and 5/2009, on second visit it states patient on an Insulin pump x 2 months, stable HgbA1C, Dx IDDM


Changed on 5/13/2011

VAERS ID: 358916 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:New York
Vaccinated:2008-04-07
Onset:2009-06-03
Submitted:2009-09-30
Entered:2009-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB256BA / 1 RA / IJ
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 19878U / 1 LA / IJ

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pollakiuria, Blood test, Type 1 diabetes mellitus

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: nothing
Current Illness: none - vaccination was given at regular 11 yr old well child care check up
Preexisting Conditions: allergic to sulfa medications PMH: Diabetes , scoliosis Allergies: Sulfa
Allergies:
Diagnostic Lab Data: blood tests
CDC 'Split Type':

Write-up: Diagnosed with Type 1 diabetes two months later. Frequent urination started 6 wks after vaccination and diagnosed with diabetes 8 wks after vaccination. 1/7/2010 PCP records for 2 wellness visits, 4/2008 and 5/2009, on second visit it states patient on an Insulin pump x 2 months, stable HgbA1C, Dx IDDM


Changed on 6/11/2011

VAERS ID: 358916 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:New York
Vaccinated:2008-04-07
Onset:2009-06-03
Submitted:2009-09-30
Entered:2009-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB256BA / 1 RA / IJ
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 19878U / 1 LA / IJ

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pollakiuria, Blood test, Type 1 diabetes mellitus

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: nothing
Current Illness: none - vaccination was given at regular 11 yr old well child care check up
Preexisting Conditions: allergic to sulfa medications PMH: Diabetes , scoliosis Allergies: Sulfa
Allergies:
Diagnostic Lab Data: blood tests
CDC 'Split Type':

Write-up: Diagnosed with Type 1 diabetes two months later. Frequent urination started 6 wks after vaccination and diagnosed with diabetes 8 wks after vaccination. 1/7/2010 PCP records for 2 wellness visits, 4/2008 and 5/2009, on second visit it states patient on an Insulin pump x 2 months, stable HgbA1C, Dx IDDM


Changed on 6/14/2014

VAERS ID: 358916 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:New York
Vaccinated:2008-04-07
Onset:2009-06-03
Submitted:2009-09-30
Entered:2009-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB256BA / 1 RA / IJ
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 19878U / 1 LA / IJ

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pollakiuria, Blood test, Type 1 diabetes mellitus

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: nothing
Current Illness: none - vaccination was given at regular 11 yr old well child care check up
Preexisting Conditions: allergic to sulfa medications PMH: Diabetes , scoliosis Allergies: Sulfa
Allergies:
Diagnostic Lab Data: blood tests
CDC 'Split Type':

Write-up: Diagnosed with Type 1 diabetes two months later. Frequent urination started 6 wks after vaccination and diagnosed with diabetes 8 wks after vaccination. 1/7/2010 PCP records for 2 wellness visits, 4/2008 and 5/2009, on second visit it states patient on an Insulin pump x 2 months, stable HgbA1C, Dx IDDM


Changed on 4/14/2017

VAERS ID: 358916 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:New York
Vaccinated:2008-04-07
Onset:2009-06-03
Submitted:2009-09-30
Entered:2009-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB256BA / 1 RA / IJ
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 19878U / 1 LA / IJ

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pollakiuria, Blood test, Type 1 diabetes mellitus

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: nothing
Current Illness: none - vaccination was given at regular 11 yr old well child care check up
Preexisting Conditions: allergic to sulfa medications PMH: Diabetes , scoliosis Allergies: Sulfa
Allergies:
Diagnostic Lab Data: blood tests
CDC 'Split Type':

Write-up: Diagnosed with Type 1 diabetes two months later. Frequent urination started 6 wks after vaccination and diagnosed with diabetes 8 wks after vaccination. 1/7/2010 PCP records for 2 wellness visits, 4/2008 and 5/2009, on second visit it states patient on an Insulin pump x 2 months, stable HgbA1C, Dx IDDM


Changed on 9/14/2017

VAERS ID: 358916 Before After
VAERS Form:(blank) 1
Age:11.0
Gender:Female
Location:New York
Vaccinated:2008-04-07
Onset:2009-06-03
Submitted:2009-09-30
Entered:2009-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB256BA / 1 2 RA / IJ
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 19878U / 1 2 LA / IJ

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pollakiuria, Blood 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: nothing
Current Illness: none - vaccination was given at regular 11 yr old well child care check up
Preexisting Conditions: allergic to sulfa medications PMH: Diabetes , scoliosis Allergies: Sulfa
Allergies:
Diagnostic Lab Data: blood tests
CDC 'Split Type':

Write-up: Diagnosed with Type 1 diabetes two months later. Frequent urination started 6 wks after vaccination and diagnosed with diabetes 8 wks after vaccination. 1/7/2010 PCP records for 2 wellness visits, 4/2008 and 5/2009, on second visit it states patient on an Insulin pump x 2 months, stable HgbA1C, Dx IDDM


Changed on 2/14/2018

VAERS ID: 358916 Before After
VAERS Form:1
Age:11.0
Gender:Female
Location:New York
Vaccinated:2008-04-07
Onset:2009-06-03
Submitted:2009-09-30
Entered:2009-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB256BA / 2 RA / IJ
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 19878U / 2 LA / IJ

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pollakiuria, Blood 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: nothing
Current Illness: none - vaccination was given at regular 11 yr old well child care check up
Preexisting Conditions: allergic to sulfa medications PMH: Diabetes , scoliosis Allergies: Sulfa
Allergies:
Diagnostic Lab Data: blood tests
CDC 'Split Type':

Write-up: Diagnosed with Type 1 diabetes two months later. Frequent urination started 6 wks after vaccination and diagnosed with diabetes 8 wks after vaccination. 1/7/2010 PCP records for 2 wellness visits, 4/2008 and 5/2009, on second visit it states patient on an Insulin pump x 2 months, stable HgbA1C, Dx IDDM


Changed on 6/14/2018

VAERS ID: 358916 Before After
VAERS Form:1
Age:11.0
Gender:Female
Location:New York
Vaccinated:2008-04-07
Onset:2009-06-03
Submitted:2009-09-30
Entered:2009-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB256BA / 2 RA / IJ
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 19878U / 2 LA / IJ

Administered by: Unknown      Purchased by: Unknown
Symptoms: Pollakiuria, Blood 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: nothing
Current Illness: none - vaccination was given at regular 11 yr old well child care check up
Preexisting Conditions: allergic to sulfa medications PMH: Diabetes , scoliosis Allergies: Sulfa
Allergies:
Diagnostic Lab Data: blood tests
CDC 'Split Type':

Write-up: Diagnosed with Type 1 diabetes two months later. Frequent urination started 6 wks after vaccination and diagnosed with diabetes 8 wks after vaccination. 1/7/2010 PCP records for 2 wellness visits, 4/2008 and 5/2009, on second visit it states patient on an Insulin pump x 2 months, stable HgbA1C, Dx IDDM

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