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This is VAERS ID 369060

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

369060
VAERS Form:
Age:15.0
Gender:Female
Location:Illinois
Vaccinated:2009-09-18
Onset:2009-11-07
Submitted:2009-11-19
Entered:2009-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 9116111 / 2 UN / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0671Y / 2 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Alanine aminotransferase decreased, Anisocytosis, Blood prolactin increased, Computerised tomogram normal, Convulsion, Depressed level of consciousness, Feeling cold, Full blood count normal, Grand mal convulsion, Headache, Microcytosis, Monocyte count decreased, Nuclear magnetic resonance imaging, Platelet morphology abnormal, Posturing, Pregnancy test urine negative, Red blood cell target cells present, Unresponsive to stimuli, Urinary incontinence, Postictal state, Hypochromasia, Drug screen negative, Tonic clonic movements, Musculoskeletal stiffness, Laboratory test normal, Mean platelet volume increased, Metabolic function test normal, Grip strength decreased

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: Learning disability; Cognitive impairment
Preexisting Conditions: FMH: Patient has first cousin with epilepsy./rem 12//8/09 Inpatient hospital records received. Service dates 11/7/09 to 11/9/09. Sickle Cell Trait (+). "Shakes a lot". Head trauma in 2002 and 2003. Learning difficulty. Behavioral problems. Stutters.
Allergies:
Diagnostic Lab Data: Magnetic resonance, results pending; computed axial, normal; diagnostic laboratory, normal 11/23/2009: LABS and DIAGNOSTICS: Cat scan WNL, BMP WNL, CBC WNL, urine pregnancy test negative and urine drug screen negative. 12//8/09 Inpatient
CDC 'Split Type': WAES0911USA02419

Write-up:Information has been received from a physician concerning a 15 year old female patient with no drug reactions/allergies and a history of learning disability and cognitive impairment who on 23-JAN-2009 was vaccinated intramuscularly with the first 0.5ml dose of GARDASIL (lot # 660557/0072X). There was no concomitant medication. On 20-MAR-2009 the patient received the second dose of GARDASIL (lot # 660557/0072X) and on 18-SEP-2009 the patient received the third dose of GARDASIL (lot # 663452/0671Y). On 07-NOV-2009 the patient developed a seizure and was hospitalized for 2 to 3 days. The physician saw the patient on 13-NOV-2009 "today" and the patient''s mother said the patient was "fine". The patient was on an unspecified antiseizure medication. A neurology consult was pending. MRI results were pending, cat scan and blood tests were normal. Seizure was considered to be immediately life-threatening and disabling. Additional information has been requested. 11/23/2009 Out-patient progress notes and laboratory test reports received for DOS 09/18/2009-11/13/2009. Assessment: Seizure Disorder Patient had generalized seizure (2 episodes). Hospitalized 11/07/2009 through 11/09/2009. Progress note of 11/13/2009 notes patient alert and oriented X3 and neuro intact. 12//8/09 Inpatient hospital records received. Service dates 11/7/09 to 11/9/09. Assessment: Generalized Tonic/Clonic Seizure. Mother heard strange noise, found patient stiff, head turned to left. Tonic/Clonic movements of limbs followed by postictal state. Urinary incontinence. Presents unresponsive. Seizure in ER. Cold sensation. Headache. Hand grasp weak. Slow to answer questions.


Changed on 7/31/2010

369060 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Illinois
Vaccinated:2009-09-18
Onset:2009-11-07
Submitted:2009-11-19
Entered:2009-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 9116111 / 2 UN / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0671Y / 2 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Alanine aminotransferase decreased, Anisocytosis, Blood prolactin increased, Computerised tomogram normal, Convulsion, Depressed level of consciousness, Feeling cold, Full blood count normal, Grand mal convulsion, Headache, Microcytosis, Monocyte count decreased, Nuclear magnetic resonance imaging, Platelet morphology abnormal, Posturing, Pregnancy test urine negative, Red blood cell target cells present, Unresponsive to stimuli, Urinary incontinence, Postictal state, Hypochromasia, Drug screen negative, Tonic clonic movements, Musculoskeletal stiffness, Laboratory test normal, Mean platelet volume increased, Metabolic function test normal, Grip strength decreased

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: Learning disability; Cognitive impairment
Preexisting Conditions: FMH: Patient has first cousin with epilepsy./rem 12//8/09 Inpatient hospital records received. Service dates 11/7/09 to 11/9/09. Sickle Cell Trait (+). "Shakes a lot". Head trauma in 2002 and 2003. Learning difficulty. Behavioral problems. Stutters.
Allergies:
Diagnostic Lab Data: Magnetic resonance, results pending; computed axial, normal; diagnostic laboratory, normal 11/23/2009: LABS and DIAGNOSTICS: Cat scan WNL, BMP WNL, CBC WNL, urine pregnancy test negative and urine drug screen negative. 12//8/09 Inpatient
CDC 'Split Type': WAES0911USA02419

Write-up:Information has been received from a physician concerning a 15 year old female patient with no drug reactions/allergies and a history of learning disability and cognitive impairment who on 23-JAN-2009 was vaccinated intramuscularly with the first 0.5ml dose of GARDASIL (lot # 660557/0072X). There was no concomitant medication. On 20-MAR-2009 the patient received the second dose of GARDASIL (lot # 660557/0072X) and on 18-SEP-2009 the patient received the third dose of GARDASIL (lot # 663452/0671Y). On 07-NOV-2009 the patient developed a seizure and was hospitalized for 2 to 3 days. The physician saw the patient on 13-NOV-2009 "today" and the patient''s mother said the patient was "fine". The patient was on an unspecified antiseizure medication. A neurology consult was pending. MRI results were pending, cat scan and blood tests were normal. Seizure was considered to be immediately life-threatening and disabling. Additional information has been requested. 11/23/2009 Out-patient progress notes and laboratory test reports received for DOS 09/18/2009-11/13/2009. Assessment: Seizure Disorder Patient had generalized seizure (2 episodes). Hospitalized 11/07/2009 through 11/09/2009. Progress note of 11/13/2009 notes patient alert and oriented X3 and neuro intact. 12//8/09 Inpatient hospital records received. Service dates 11/7/09 to 11/9/09. Assessment: Generalized Tonic/Clonic Seizure. Mother heard strange noise, found patient stiff, head turned to left. Tonic/Clonic movements of limbs followed by postictal state. Urinary incontinence. Presents unresponsive. Seizure in ER. Cold sensation. Headache. Hand grasp weak. Slow to answer questions.


Changed on 1/4/2011

369060 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Illinois
Vaccinated:2009-09-18
Onset:2009-11-07
Submitted:2009-11-19
Entered:2009-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 9116111 / 2 UN / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0671Y / 2 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Computerised tomogram normal, Convulsion, Full blood count normal, Nuclear magnetic resonance imaging, Pregnancy test urine negative, Drug screen negative, Laboratory test normal, Metabolic function test normal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: Learning disability; Cognitive impairment
Preexisting Conditions: FMH: Patient has first cousin with epilepsy./rem 12//8/09 Inpatient hospital records received. Service dates 11/7/09 to 11/9/09. Sickle Cell Trait (+). "Shakes a lot". Head trauma in 2002 and 2003. Learning difficulty. Behavioral problems. Stutters.
Allergies:
Diagnostic Lab Data: Magnetic resonance, results pending; computed axial, normal; diagnostic laboratory, normal 11/23/2009: LABS and DIAGNOSTICS: Cat scan WNL, BMP WNL, CBC WNL, urine pregnancy test negative and urine drug screen negative. 12//8/09 Inpatient hospital records received. Service dates 11/7/09 to 11/9/09. LABS and DIAGNOSTICS: CBC - MPV 11.5 FL (H) MONO ABS 0.5 CT/MM3 (L), MICRO 2+, ANISO 1+, TARG 1+, HYPO 1+, G.PLT Present. CHEM - ALT 9 IU/L (L) Prolactin 30 NG/ML (H). CT Brain - WNL.
CDC 'Split Type': WAES0911USA02419

Write-up:Information has been received from a physician concerning a 15 year old female patient with no drug reactions/allergies and a history of learning disability and cognitive impairment who on 23-JAN-2009 was vaccinated intramuscularly with the first 0.5ml dose of GARDASIL (lot # 660557/0072X). There was no concomitant medication. On 20-MAR-2009 the patient received the second dose of GARDASIL (lot # 660557/0072X) and on 18-SEP-2009 the patient received the third dose of GARDASIL (lot # 663452/0671Y). On 07-NOV-2009 the patient developed a seizure and was hospitalized for 2 to 3 days. The physician saw the patient on 13-NOV-2009 "today" and the patient''s mother said the patient was "fine". The patient was on an unspecified antiseizure medication. A neurology consult was pending. MRI results were pending, cat scan and blood tests were normal. Seizure was considered to be immediately life-threatening and disabling. Additional information has been requested. 11/23/2009 Out-patient progress notes and laboratory test reports received for DOS 09/18/2009-11/13/2009. Assessment: Seizure Disorder Patient had generalized seizure (2 episodes). Hospitalized 11/07/2009 through 11/09/2009. Progress note of 11/13/2009 notes patient alert and oriented X3 and neuro intact. 12//8/09 Inpatient hospital records received. Service dates 11/7/09 to 11/9/09. Assessment: Generalized Tonic/Clonic Seizure. Mother heard strange noise, found patient stiff, head turned to left. Tonic/Clonic movements of limbs followed by postictal state. Urinary incontinence. Presents unresponsive. Seizure in ER. Cold sensation. Headache. Hand grasp weak. Slow to answer questions.


Changed on 4/13/2011

369060 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Illinois
Vaccinated:2009-09-18
Onset:2009-11-07
Submitted:2009-11-19
Entered:2009-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 9116111 / 2 UN / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0671Y / 2 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Alanine aminotransferase decreased, Anisocytosis, Blood prolactin increased, Computerised tomogram normal, Convulsion, Depressed level of consciousness, Feeling cold, Full blood count normal, Grand mal convulsion, Headache, Microcytosis, Monocyte count decreased, Nuclear magnetic resonance imaging, Platelet morphology abnormal, Posturing, Pregnancy test urine negative, Red blood cell target cells present, Unresponsive to stimuli, Urinary incontinence, Postictal state, Hypochromasia, Drug screen negative, Tonic clonic movements, Musculoskeletal stiffness, Laboratory test normal, Mean platelet volume increased, Metabolic function test normal, Grip strength decreased

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: Learning disability; Cognitive impairment
Preexisting Conditions: FMH: Patient has first cousin with epilepsy./rem 12//8/09 Inpatient hospital records received. Service dates 11/7/09 to 11/9/09. Sickle Cell Trait (+). "Shakes a lot". Head trauma in 2002 and 2003. Learning difficulty. Behavioral problems. Stutters.
Allergies:
Diagnostic Lab Data: Magnetic resonance, results pending; computed axial, normal; diagnostic laboratory, normal 11/23/2009: LABS and DIAGNOSTICS: Cat scan WNL, BMP WNL, CBC WNL, urine pregnancy test negative and urine drug screen negative. 12//8/09 Inpatient hospital records received. Service dates 11/7/09 to 11/9/09. LABS and DIAGNOSTICS: CBC - MPV 11.5 FL (H) MONO ABS 0.5 CT/MM3 (L), MICRO 2+, ANISO 1+, TARG 1+, HYPO 1+, G.PLT Present. CHEM - ALT 9 IU/L (L) Prolactin 30 NG/ML (H). CT Brain - WNL.
CDC 'Split Type': WAES0911USA02419

Write-up:Information has been received from a physician concerning a 15 year old female patient with no drug reactions/allergies and a history of learning disability and cognitive impairment who on 23-JAN-2009 was vaccinated intramuscularly with the first 0.5ml dose of GARDASIL (lot # 660557/0072X). There was no concomitant medication. On 20-MAR-2009 the patient received the second dose of GARDASIL (lot # 660557/0072X) and on 18-SEP-2009 the patient received the third dose of GARDASIL (lot # 663452/0671Y). On 07-NOV-2009 the patient developed a seizure and was hospitalized for 2 to 3 days. The physician saw the patient on 13-NOV-2009 "today" and the patient''s mother said the patient was "fine". The patient was on an unspecified antiseizure medication. A neurology consult was pending. MRI results were pending, cat scan and blood tests were normal. Seizure was considered to be immediately life-threatening and disabling. Additional information has been requested. 11/23/2009 Out-patient progress notes and laboratory test reports received for DOS 09/18/2009-11/13/2009. Assessment: Seizure Disorder Patient had generalized seizure (2 episodes). Hospitalized 11/07/2009 through 11/09/2009. Progress note of 11/13/2009 notes patient alert and oriented X3 and neuro intact. 12//8/09 Inpatient hospital records received. Service dates 11/7/09 to 11/9/09. Assessment: Generalized Tonic/Clonic Seizure. Mother heard strange noise, found patient stiff, head turned to left. Tonic/Clonic movements of limbs followed by postictal state. Urinary incontinence. Presents unresponsive. Seizure in ER. Cold sensation. Headache. Hand grasp weak. Slow to answer questions.


Changed on 5/13/2011

369060 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Illinois
Vaccinated:2009-09-18
Onset:2009-11-07
Submitted:2009-11-19
Entered:2009-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 9116111 / 2 UN / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0671Y / 2 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Alanine aminotransferase decreased, Anisocytosis, Blood prolactin increased, Computerised tomogram normal, Convulsion, Depressed level of consciousness, Feeling cold, Full blood count normal, Grand mal convulsion, Headache, Microcytosis, Monocyte count decreased, Nuclear magnetic resonance imaging, Platelet morphology abnormal, Posturing, Pregnancy test urine negative, Red blood cell target cells present, Unresponsive to stimuli, Urinary incontinence, Postictal state, Hypochromasia, Drug screen negative, Tonic clonic movements, Musculoskeletal stiffness, Laboratory test normal, Mean platelet volume increased, Metabolic function test normal, Grip strength decreased

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: Learning disability; Cognitive impairment
Preexisting Conditions: FMH: Patient has first cousin with epilepsy./rem 12//8/09 Inpatient hospital records received. Service dates 11/7/09 to 11/9/09. Sickle Cell Trait (+). "Shakes a lot". Head trauma in 2002 and 2003. Learning difficulty. Behavioral problems. Stutters.
Allergies:
Diagnostic Lab Data: Magnetic resonance, results pending; computed axial, normal; diagnostic laboratory, normal 11/23/2009: LABS and DIAGNOSTICS: Cat scan WNL, BMP WNL, CBC WNL, urine pregnancy test negative and urine drug screen negative. 12//8/09 Inpatient hospital records received. Service dates 11/7/09 to 11/9/09. LABS and DIAGNOSTICS: CBC - MPV 11.5 FL (H) MONO ABS 0.5 CT/MM3 (L), MICRO 2+, ANISO 1+, TARG 1+, HYPO 1+, G.PLT Present. CHEM - ALT 9 IU/L (L) Prolactin 30 NG/ML (H). CT Brain - WNL.
CDC 'Split Type': WAES0911USA02419

Write-up:Information has been received from a physician concerning a 15 year old female patient with no drug reactions/allergies and a history of learning disability and cognitive impairment who on 23-JAN-2009 was vaccinated intramuscularly with the first 0.5ml dose of GARDASIL (lot # 660557/0072X). There was no concomitant medication. On 20-MAR-2009 the patient received the second dose of GARDASIL (lot # 660557/0072X) and on 18-SEP-2009 the patient received the third dose of GARDASIL (lot # 663452/0671Y). On 07-NOV-2009 the patient developed a seizure and was hospitalized for 2 to 3 days. The physician saw the patient on 13-NOV-2009 "today" and the patient''s mother said the patient was "fine". The patient was on an unspecified antiseizure medication. A neurology consult was pending. MRI results were pending, cat scan and blood tests were normal. Seizure was considered to be immediately life-threatening and disabling. Additional information has been requested. 11/23/2009 Out-patient progress notes and laboratory test reports received for DOS 09/18/2009-11/13/2009. Assessment: Seizure Disorder Patient had generalized seizure (2 episodes). Hospitalized 11/07/2009 through 11/09/2009. Progress note of 11/13/2009 notes patient alert and oriented X3 and neuro intact. 12//8/09 Inpatient hospital records received. Service dates 11/7/09 to 11/9/09. Assessment: Generalized Tonic/Clonic Seizure. Mother heard strange noise, found patient stiff, head turned to left. Tonic/Clonic movements of limbs followed by postictal state. Urinary incontinence. Presents unresponsive. Seizure in ER. Cold sensation. Headache. Hand grasp weak. Slow to answer questions.


Changed on 6/11/2011

369060 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Illinois
Vaccinated:2009-09-18
Onset:2009-11-07
Submitted:2009-11-19
Entered:2009-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 9116111 / 2 UN / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0671Y / 2 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Alanine aminotransferase decreased, Anisocytosis, Blood prolactin increased, Computerised tomogram normal, Convulsion, Depressed level of consciousness, Feeling cold, Full blood count normal, Grand mal convulsion, Headache, Microcytosis, Monocyte count decreased, Nuclear magnetic resonance imaging, Platelet morphology abnormal, Posturing, Pregnancy test urine negative, Red blood cell target cells present, Unresponsive to stimuli, Urinary incontinence, Postictal state, Hypochromasia, Drug screen negative, Tonic clonic movements, Musculoskeletal stiffness, Laboratory test normal, Mean platelet volume increased, Metabolic function test normal, Grip strength decreased

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: Learning disability; Cognitive impairment
Preexisting Conditions: FMH: Patient has first cousin with epilepsy./rem 12//8/09 Inpatient hospital records received. Service dates 11/7/09 to 11/9/09. Sickle Cell Trait (+). "Shakes a lot". Head trauma in 2002 and 2003. Learning difficulty. Behavioral problems. Stutters.
Allergies:
Diagnostic Lab Data: Magnetic resonance, results pending; computed axial, normal; diagnostic laboratory, normal 11/23/2009: LABS and DIAGNOSTICS: Cat scan WNL, BMP WNL, CBC WNL, urine pregnancy test negative and urine drug screen negative. 12//8/09 Inpatient hospital records received. Service dates 11/7/09 to 11/9/09. LABS and DIAGNOSTICS: CBC - MPV 11.5 FL (H) MONO ABS 0.5 CT/MM3 (L), MICRO 2+, ANISO 1+, TARG 1+, HYPO 1+, G.PLT Present. CHEM - ALT 9 IU/L (L) Prolactin 30 NG/ML (H). CT Brain - WNL.
CDC 'Split Type': WAES0911USA02419

Write-up:Information has been received from a physician concerning a 15 year old female patient with no drug reactions/allergies and a history of learning disability and cognitive impairment who on 23-JAN-2009 was vaccinated intramuscularly with the first 0.5ml dose of GARDASIL (lot # 660557/0072X). There was no concomitant medication. On 20-MAR-2009 the patient received the second dose of GARDASIL (lot # 660557/0072X) and on 18-SEP-2009 the patient received the third dose of GARDASIL (lot # 663452/0671Y). On 07-NOV-2009 the patient developed a seizure and was hospitalized for 2 to 3 days. The physician saw the patient on 13-NOV-2009 "today" and the patient''s mother said the patient was "fine". The patient was on an unspecified antiseizure medication. A neurology consult was pending. MRI results were pending, cat scan and blood tests were normal. Seizure was considered to be immediately life-threatening and disabling. Additional information has been requested. 11/23/2009 Out-patient progress notes and laboratory test reports received for DOS 09/18/2009-11/13/2009. Assessment: Seizure Disorder Patient had generalized seizure (2 episodes). Hospitalized 11/07/2009 through 11/09/2009. Progress note of 11/13/2009 notes patient alert and oriented X3 and neuro intact. 12//8/09 Inpatient hospital records received. Service dates 11/7/09 to 11/9/09. Assessment: Generalized Tonic/Clonic Seizure. Mother heard strange noise, found patient stiff, head turned to left. Tonic/Clonic movements of limbs followed by postictal state. Urinary incontinence. Presents unresponsive. Seizure in ER. Cold sensation. Headache. Hand grasp weak. Slow to answer questions.


Changed on 6/14/2014

369060 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Illinois
Vaccinated:2009-09-18
Onset:2009-11-07
Submitted:2009-11-19
Entered:2009-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 9116111 / 2 UN / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0671Y / 2 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Alanine aminotransferase decreased, Anisocytosis, Blood prolactin increased, Computerised tomogram normal, Convulsion, Depressed level of consciousness, Feeling cold, Full blood count normal, Grand mal convulsion, Headache, Microcytosis, Monocyte count decreased, Nuclear magnetic resonance imaging, Platelet morphology abnormal, Posturing, Pregnancy test urine negative, Red blood cell target cells present, Unresponsive to stimuli, Urinary incontinence, Postictal state, Hypochromasia, Drug screen negative, Tonic clonic movements, Musculoskeletal stiffness, Laboratory test normal, Mean platelet volume increased, Metabolic function test normal, Grip strength decreased

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: Learning disability; Cognitive impairment
Preexisting Conditions: FMH: Patient has first cousin with epilepsy./rem 12//8/09 Inpatient hospital records received. Service dates 11/7/09 to 11/9/09. Sickle Cell Trait (+). "Shakes a lot". Head trauma in 2002 and 2003. Learning difficulty. Behavioral problems. Stutters.
Allergies:
Diagnostic Lab Data: Magnetic resonance, results pending; computed axial, normal; diagnostic laboratory, normal 11/23/2009: LABS and DIAGNOSTICS: Cat scan WNL, BMP WNL, CBC WNL, urine pregnancy test negative and urine drug screen negative. 12//8/09 Inpatient hospital records received. Service dates 11/7/09 to 11/9/09. LABS and DIAGNOSTICS: CBC - MPV 11.5 FL (H) MONO ABS 0.5 CT/MM3 (L), MICRO 2+, ANISO 1+, TARG 1+, HYPO 1+, G.PLT Present. CHEM - ALT 9 IU/L (L) Prolactin 30 NG/ML (H). CT Brain - WNL.
CDC 'Split Type': WAES0911USA02419

Write-up:Information has been received from a physician concerning a 15 year old female patient with no drug reactions/allergies and a history of learning disability and cognitive impairment who on 23-JAN-2009 was vaccinated intramuscularly with the first 0.5ml dose of GARDASIL (lot # 660557/0072X). There was no concomitant medication. On 20-MAR-2009 the patient received the second dose of GARDASIL (lot # 660557/0072X) and on 18-SEP-2009 the patient received the third dose of GARDASIL (lot # 663452/0671Y). On 07-NOV-2009 the patient developed a seizure and was hospitalized for 2 to 3 days. The physician saw the patient on 13-NOV-2009 "today" and the patient''s mother said the patient was "fine". The patient was on an unspecified antiseizure medication. A neurology consult was pending. MRI results were pending, cat scan and blood tests were normal. Seizure was considered to be immediately life-threatening and disabling. Additional information has been requested. 11/23/2009 Out-patient progress notes and laboratory test reports received for DOS 09/18/2009-11/13/2009. Assessment: Seizure Disorder Patient had generalized seizure (2 episodes). Hospitalized 11/07/2009 through 11/09/2009. Progress note of 11/13/2009 notes patient alert and oriented X3 and neuro intact. 12//8/09 Inpatient hospital records received. Service dates 11/7/09 to 11/9/09. Assessment: Generalized Tonic/Clonic Seizure. Mother heard strange noise, found patient stiff, head turned to left. Tonic/Clonic movements of limbs followed by postictal state. Urinary incontinence. Presents unresponsive. Seizure in ER. Cold sensation. Headache. Hand grasp weak. Slow to answer questions.


Changed on 4/14/2017

369060 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Illinois
Vaccinated:2009-09-18
Onset:2009-11-07
Submitted:2009-11-19
Entered:2009-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 9116111 / 2 UN / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0671Y / 2 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Alanine aminotransferase decreased, Anisocytosis, Blood prolactin increased, Computerised tomogram normal, Convulsion, Depressed level of consciousness, Feeling cold, Full blood count normal, Grand mal convulsion, Headache, Microcytosis, Monocyte count decreased, Nuclear magnetic resonance imaging, Platelet morphology abnormal, Posturing, Pregnancy test urine negative, Red blood cell target cells present, Unresponsive to stimuli, Urinary incontinence, Postictal state, Hypochromasia, Drug screen negative, Tonic clonic movements, Musculoskeletal stiffness, Laboratory test normal, Mean platelet volume increased, Metabolic function test normal, Grip strength decreased

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: Learning disability; Cognitive impairment
Preexisting Conditions: FMH: Patient has first cousin with epilepsy./rem 12//8/09 Inpatient hospital records received. Service dates 11/7/09 to 11/9/09. Sickle Cell Trait (+). "Shakes a lot". Head trauma in 2002 and 2003. Learning difficulty. Behavioral problems. Stutters.
Allergies:
Diagnostic Lab Data: Magnetic resonance, results pending; computed axial, normal; diagnostic laboratory, normal 11/23/2009: LABS and DIAGNOSTICS: Cat scan WNL, BMP WNL, CBC WNL, urine pregnancy test negative and urine drug screen negative. 12//8/09 Inpatient hospital records received. Service dates 11/7/09 to 11/9/09. LABS and DIAGNOSTICS: CBC - MPV 11.5 FL (H) MONO ABS 0.5 CT/MM3 (L), MICRO 2+, ANISO 1+, TARG 1+, HYPO 1+, G.PLT Present. CHEM - ALT 9 IU/L (L) Prolactin 30 NG/ML (H). CT Brain - WNL.
CDC 'Split Type': WAES0911USA02419

Write-up:Information has been received from a physician concerning a 15 year old female patient with no drug reactions/allergies and a history of learning disability and cognitive impairment who on 23-JAN-2009 was vaccinated intramuscularly with the first 0.5ml dose of GARDASIL (lot # 660557/0072X). There was no concomitant medication. On 20-MAR-2009 the patient received the second dose of GARDASIL (lot # 660557/0072X) and on 18-SEP-2009 the patient received the third dose of GARDASIL (lot # 663452/0671Y). On 07-NOV-2009 the patient developed a seizure and was hospitalized for 2 to 3 days. The physician saw the patient on 13-NOV-2009 "today" and the patient''s mother said the patient was "fine". The patient was on an unspecified antiseizure medication. A neurology consult was pending. MRI results were pending, cat scan and blood tests were normal. Seizure was considered to be immediately life-threatening and disabling. Additional information has been requested. 11/23/2009 Out-patient progress notes and laboratory test reports received for DOS 09/18/2009-11/13/2009. Assessment: Seizure Disorder Patient had generalized seizure (2 episodes). Hospitalized 11/07/2009 through 11/09/2009. Progress note of 11/13/2009 notes patient alert and oriented X3 and neuro intact. 12//8/09 Inpatient hospital records received. Service dates 11/7/09 to 11/9/09. Assessment: Generalized Tonic/Clonic Seizure. Mother heard strange noise, found patient stiff, head turned to left. Tonic/Clonic movements of limbs followed by postictal state. Urinary incontinence. Presents unresponsive. Seizure in ER. Cold sensation. Headache. Hand grasp weak. Slow to answer questions.


Changed on 9/14/2017

369060 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:Illinois
Vaccinated:2009-09-18
Onset:2009-11-07
Submitted:2009-11-19
Entered:2009-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 9116111 / 2 3 UN / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0671Y / 2 3 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Computerised tomogram normal, Convulsion, Full blood count normal, Nuclear magnetic resonance imaging, Pregnancy test urine negative, Drug screen negative, Laboratory test normal, Metabolic function test normal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: Learning disability; Cognitive impairment
Preexisting Conditions: FMH: Patient has first cousin with epilepsy./rem 12//8/09 Inpatient hospital records received. Service dates 11/7/09 to 11/9/09. Sickle Cell Trait (+). "Shakes a lot". Head trauma in 2002 and 2003. Learning difficulty. Behavioral problems. Stutters.
Allergies:
Diagnostic Lab Data: Magnetic resonance, results pending; computed axial, normal; diagnostic laboratory, normal 11/23/2009: LABS and DIAGNOSTICS: Cat scan WNL, BMP WNL, CBC WNL, urine pregnancy test negative and urine drug screen negative. 12//8/09 Inpatient hospital records received. Service dates 11/7/09 to 11/9/09. LABS and DIAGNOSTICS: CBC - MPV 11.5 FL (H) MONO ABS 0.5 CT/MM3 (L), MICRO 2+, ANISO 1+, TARG 1+, HYPO 1+, G.PLT Present. CHEM - ALT 9 IU/L (L) Prolactin 30 NG/ML (H). CT Brain - WNL.
CDC 'Split Type': WAES0911USA02419

Write-up:Information has been received from a physician concerning a 15 year old female patient with no drug reactions/allergies and a history of learning disability and cognitive impairment who on 23-JAN-2009 was vaccinated intramuscularly with the first 0.5ml dose of GARDASIL (lot # 660557/0072X). There was no concomitant medication. On 20-MAR-2009 the patient received the second dose of GARDASIL (lot # 660557/0072X) and on 18-SEP-2009 the patient received the third dose of GARDASIL (lot # 663452/0671Y). On 07-NOV-2009 the patient developed a seizure and was hospitalized for 2 to 3 days. The physician saw the patient on 13-NOV-2009 "today" and the patient''s mother said the patient was "fine". The patient was on an unspecified antiseizure medication. A neurology consult was pending. MRI results were pending, cat scan and blood tests were normal. Seizure was considered to be immediately life-threatening and disabling. Additional information has been requested. 11/23/2009 Out-patient progress notes and laboratory test reports received for DOS 09/18/2009-11/13/2009. Assessment: Seizure Disorder Patient had generalized seizure (2 episodes). Hospitalized 11/07/2009 through 11/09/2009. Progress note of 11/13/2009 notes patient alert and oriented X3 and neuro intact. 12//8/09 Inpatient hospital records received. Service dates 11/7/09 to 11/9/09. Assessment: Generalized Tonic/Clonic Seizure. Mother heard strange noise, found patient stiff, head turned to left. Tonic/Clonic movements of limbs followed by postictal state. Urinary incontinence. Presents unresponsive. Seizure in ER. Cold sensation. Headache. Hand grasp weak. Slow to answer questions.


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