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This is VAERS ID 359040

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

359040
VAERS Form:
Age:
Gender:Female
Location:Tennessee
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2009-09-30
Entered:2009-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Gait disturbance

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0909USA03751

Write-up:Information has been received from a physician who "heard from a patient that someone related to her friend", a female, who was vaccinated with her second dose GARDASIL on an unspecified date. Subsequently the patient required assistance in walking. The patient might have been treated at a hospital. At the time of the report, the patient''s status was unknown. Follow up information on 25-SEP-2009 has been received through a phone call from a physician. The physician stated that she did not know any information of the patient. She would ask the person who report the case to get the patient''s adverse experience. Required assistance in walking was considered to be disabling. The Health Care Professional contacted during telephone follow-up could not supply the following information: patient name, date of birth, dates of vaccination/therapy, dose number (if applicable), lot number, date of event, recovery status, hospital name (if applicable), healthcare provider name and contact information. No further information is available at this time. Additional information has been requested.


Changed on 9/14/2017

359040 Before After
VAERS Form:(blank) 1
Age:
Gender:Female
Location:Tennessee
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2009-09-30
Entered:2009-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Gait disturbance

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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES0909USA03751

Write-up:Information has been received from a physician who "heard from a patient that someone related to her friend", a female, who was vaccinated with her second dose GARDASIL on an unspecified date. Subsequently the patient required assistance in walking. The patient might have been treated at a hospital. At the time of the report, the patient''s status was unknown. Follow up information on 25-SEP-2009 has been received through a phone call from a physician. The physician stated that she did not know any information of the patient. She would ask the person who report the case to get the patient''s adverse experience. Required assistance in walking was considered to be disabling. The Health Care Professional contacted during telephone follow-up could not supply the following information: patient name, date of birth, dates of vaccination/therapy, dose number (if applicable), lot number, date of event, recovery status, hospital name (if applicable), healthcare provider name and contact information. No further information is available at this time. Additional information has been requested.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=359040&WAYBACKHISTORY=ON


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