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This is VAERS ID 379853

History of Changes from the VAERS Wayback Machine

First Appeared on 3/2/2010

379853
VAERS Form:
Age:15.0
Gender:Female
Location:Florida
Vaccinated:2007-02-28
Onset:2007-10-01
Submitted:2010-02-05
Entered:2010-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1213F / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0012U / 1 UN / UN
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2562AA / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Benign intracranial hypertension, Bronchitis, CSF pressure increased, Decreased activity, Headache, Lumbar puncture, Muscle twitching, Nausea, Paraesthesia, Rash, Urticaria, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 30     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: Bronchitis
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown ``02/15/10 LABS and DIAGNOSTICS: Ct-normal, MRI-abnormal (abnormal clivus), LP-abnormal (elevated opening pressure), CSF cult-neg., Bone scan-normal (no abnormality or bony lesion of the clivus), Three-view cervical spine x-ray-n
CDC 'Split Type': WAES1001USA03372

Write-up:Information has been received from a health professional concerning her daughter an 18 year old female who in October 2007, was vaccinated with the first dose of GARDASIL (lot number not reported). There were no pertinent medical history and drug reactions/allergies. Concomitant therapy included RECOMBIVAX HB (unspecified). The healthcare worker reported that her daughter developed "stabbing head pain associated with a twitch" in approximately October 2007 about 2 weeks after she received her first dose of GARDASIL. The patient had been diagnosed with pseudotumor cerebri which limited her physical activity and she was hospitalized. The patient''s pseudotumor cerebri persisted. The patient underwent lumbar puncture to relieve fluid pressure. Multiple unspecified blood tests and diagnostic studies were performed with results not report. Pseudotumor cerebri was considered to be disabling, immediately life-threatening and an other important medical event by the healthcare worker. Follow up information was received from a healthcare professional who reported the patient was vaccinated with the first dose of GARDASIL on 28-FEB-2007, the second dose of GARDASIL on 15-OCT-2007, and the third dose of GARDASIL on 01-JUL-2008 (lot numbers not reported). Concomitant vaccine included MENACTRA received on 28-FEB-2007 and VAQTA (unspecified) received on 28-FEB-2007 and 15-OCT-2007 (lot number not reported). At the 28-FEB-2007 office visit, the patient had bronchitis. At the 15-OCT-2007 office visit, there was no mention of any adverse event. On 23-OCT-2007, the patient was seen for hives and ZYRTEC was given. On 30-OCT-2007, the patient complained of pins and needles all over, rash was gone. On 28-NOV-2007, the patient complained of blurred vision, and a neuro consult was directed. In November and December 2007, the patient was admitted to the hospital (no other details available). In November 2008, the patient was admitted for nausea, vomiting and headache (no other details). On 05-JUN-2009, the patient was last seen in their o


Changed on 4/7/2010

379853 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Florida
Vaccinated:2007-02-28
Onset:2007-10-01
Submitted:2010-02-05
Entered:2010-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1213F / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0012U / 1 UN / UN
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2562AA / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Antinuclear antibody negative, Benign intracranial hypertension, Blood iron normal, Bronchitis, Computerised tomogram normal, CSF culture negative, CSF pressure increased, Decreased activity, Diplopia, Headache, Intracranial pressure increased, Lumbar puncture, Lumbar puncture abnormal, Muscle twitching, Nausea, Nuclear magnetic resonance imaging abnormal, Pain, Paraesthesia, Rash, Spinal X-ray normal, Thyroid function test normal, Urticaria, Vision blurred, Visual impairment, Vomiting, Bone scan normal, Brain scan normal, Metabolic function test normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 30     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: Bronchitis
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown ``02/15/10 LABS and DIAGNOSTICS: Ct-normal, MRI-abnormal (abnormal clivus), LP-abnormal (elevated opening pressure), CSF cult-neg., Bone scan-normal (no abnormality or bony lesion of the clivus), Three-view cervical spine x-ray-n
CDC 'Split Type': WAES1001USA03372

Write-up:Information has been received from a health professional concerning her daughter an 18 year old female who in October 2007, was vaccinated with the first dose of GARDASIL (lot number not reported). There were no pertinent medical history and drug reactions/allergies. Concomitant therapy included RECOMBIVAX HB (unspecified). The healthcare worker reported that her daughter developed "stabbing head pain associated with a twitch" in approximately October 2007 about 2 weeks after she received her first dose of GARDASIL. The patient had been diagnosed with pseudotumor cerebri which limited her physical activity and she was hospitalized. The patient''s pseudotumor cerebri persisted. The patient underwent lumbar puncture to relieve fluid pressure. Multiple unspecified blood tests and diagnostic studies were performed with results not report. Pseudotumor cerebri was considered to be disabling, immediately life-threatening and an other important medical event by the healthcare worker. Follow up information was received from a healthcare professional who reported the patient was vaccinated with the first dose of GARDASIL on 28-FEB-2007, the second dose of GARDASIL on 15-OCT-2007, and the third dose of GARDASIL on 01-JUL-2008 (lot numbers not reported). Concomitant vaccine included MENACTRA received on 28-FEB-2007 and VAQTA (unspecified) received on 28-FEB-2007 and 15-OCT-2007 (lot number not reported). At the 28-FEB-2007 office visit, the patient had bronchitis. At the 15-OCT-2007 office visit, there was no mention of any adverse event. On 23-OCT-2007, the patient was seen for hives and ZYRTEC was given. On 30-OCT-2007, the patient complained of pins and needles all over, rash was gone. On 28-NOV-2007, the patient complained of blurred vision, and a neuro consult was directed. In November and December 2007, the patient was admitted to the hospital (no other details available). In November 2008, the patient was admitted for nausea, vomiting and headache (no other details). On 05-JUN-2009, the patient was last seen in their o


Changed on 8/31/2010

379853 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Florida
Vaccinated:2007-02-28
Onset:2007-10-01
Submitted:2010-02-05
Entered:2010-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1213F / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0012U / 1 UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2562AA / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Antinuclear antibody negative, Benign intracranial hypertension, Blood iron normal, Bronchitis, Computerised tomogram normal, CSF culture negative, CSF pressure increased, Decreased activity, Diplopia, Headache, Intracranial pressure increased, Lumbar puncture, Lumbar puncture abnormal, Muscle twitching, Nausea, Nuclear magnetic resonance imaging abnormal, Pain, Paraesthesia, Rash, Spinal X-ray normal, Thyroid function test normal, Urticaria, Vision blurred, Visual disturbance, Visual impairment, Vomiting, Laboratory test, Blood test, Bone scan normal, Brain scan normal, Metabolic function test normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 30     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: Bronchitis
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown ``02/15/10 LABS and DIAGNOSTICS: Ct-normal, MRI-abnormal (abnormal clivus), LP-abnormal (elevated opening pressure), CSF cult-neg., Bone scan-normal (no abnormality or bony lesion of the clivus), Three-view cervical spine x-ray-n
CDC 'Split Type': WAES1001USA03372

Write-up:Information has been received from a health professional concerning her daughter an 18 year old female who in October 2007, was vaccinated with the first dose of GARDASIL (lot number not reported). There were no pertinent medical history and drug reactions/allergies. Concomitant therapy included RECOMBIVAX HB (unspecified). The healthcare worker reported that her daughter developed "stabbing head pain associated with a twitch" in approximately October 2007 about 2 weeks after she received her first dose of GARDASIL. The patient had been diagnosed with pseudotumor cerebri which limited her physical activity and she was hospitalized. The patient''s pseudotumor cerebri persisted. The patient underwent lumbar puncture to relieve fluid pressure. Multiple unspecified blood tests and diagnostic studies were performed with results not report. Pseudotumor cerebri was considered to be disabling, immediately life-threatening and an other important medical event by the healthcare worker. Follow up information was received from a healthcare professional who reported the patient was vaccinated with the first dose of GARDASIL on 28-FEB-2007, the second dose of GARDASIL on 15-OCT-2007, and the third dose of GARDASIL on 01-JUL-2008 (lot numbers not reported). Concomitant vaccine included MENACTRA received on 28-FEB-2007 and VAQTA (unspecified) received on 28-FEB-2007 and 15-OCT-2007 (lot number not reported). At the 28-FEB-2007 office visit, the patient had bronchitis. At the 15-OCT-2007 office visit, there was no mention of any adverse event. On 23-OCT-2007, the patient was seen for hives and ZYRTEC was given. On 30-OCT-2007, the patient complained of pins and needles all over, rash was gone. On 28-NOV-2007, the patient complained of blurred vision, and a neuro consult was directed. In November and December 2007, the patient was admitted to the hospital (no other details available). In November 2008, the patient was admitted for nausea, vomiting and headache (no other details). On 05-JUN-2009, the patient was last seen in their o


Changed on 1/4/2011

379853 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Florida
Vaccinated:2007-02-28
Onset:2007-10-01
Submitted:2010-02-05
Entered:2010-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1213F / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0012U / 1 UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2562AA / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Antinuclear antibody negative, Benign intracranial hypertension, Blood iron normal, Bronchitis, Computerised tomogram normal, CSF culture negative, CSF pressure increased, Decreased activity, Diplopia, Headache, Intracranial pressure increased, Lumbar puncture, Lumbar puncture abnormal, Muscle twitching, Nausea, Nuclear magnetic resonance imaging abnormal, Pain, Paraesthesia, Rash, Spinal X-ray normal, Thyroid function test normal, Urticaria, Vision blurred, Visual disturbance, Visual impairment, Vomiting, Laboratory test, Blood test, Bone scan normal, Brain scan normal, Metabolic function test normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 30     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: Bronchitis
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown ``02/15/10 LABS and DIAGNOSTICS: Ct-normal, MRI-abnormal (abnormal clivus), LP-abnormal (elevated opening pressure), CSF cult-neg., Bone scan-normal (no abnormality or bony lesion of the clivus), Three-view cervical spine x-ray-n x-ray-normal (no evidence of instability), Venography MR of brain- neg (congenitally small L. transverse & sigmoid sinuses[normal variant], No evidence of thrombosis or occlusion of sinuses of brain), Thyroid antibody thyroid function test-normal, Iron studies-normal, Vit A- WNL, ANA-neg., .
CDC 'Split Type': WAES1001USA03372

Write-up:Information has been received from a health professional concerning her daughter an 18 year old female who in October 2007, was vaccinated with the first dose of GARDASIL (lot number not reported). There were no pertinent medical history and drug reactions/allergies. Concomitant therapy included RECOMBIVAX HB (unspecified). The healthcare worker reported that her daughter developed "stabbing head pain associated with a twitch" in approximately October 2007 about 2 weeks after she received her first dose of GARDASIL. The patient had been diagnosed with pseudotumor cerebri which limited her physical activity and she was hospitalized. The patient''s pseudotumor cerebri persisted. The patient underwent lumbar puncture to relieve fluid pressure. Multiple unspecified blood tests and diagnostic studies were performed with results not report. Pseudotumor cerebri was considered to be disabling, immediately life-threatening and an other important medical event by the healthcare worker. Follow up information was received from a healthcare professional who reported the patient was vaccinated with the first dose of GARDASIL on 28-FEB-2007, the second dose of GARDASIL on 15-OCT-2007, and the third dose of GARDASIL on 01-JUL-2008 (lot numbers not reported). Concomitant vaccine included MENACTRA received on 28-FEB-2007 and VAQTA (unspecified) received on 28-FEB-2007 and 15-OCT-2007 (lot number not reported). At the 28-FEB-2007 office visit, the patient had bronchitis. At the 15-OCT-2007 office visit, there was no mention of any adverse event. On 23-OCT-2007, the patient was seen for hives and ZYRTEC was given. On 30-OCT-2007, the patient complained of pins and needles all over, rash was gone. On 28-NOV-2007, the patient complained of blurred vision, and a neuro consult was directed. In November and December 2007, the patient was admitted to the hospital (no other details available). In November 2008, the patient was admitted for nausea, vomiting and headache (no other details). On 05-JUN-2009, the patient was last seen in their o office. Additional information has been requested.


Changed on 3/14/2015

379853 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Florida
Vaccinated:2007-02-28
Onset:2007-10-01
Submitted:2010-02-05
Entered:2010-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1213F / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0012U / 1 UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2562AA / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Antinuclear antibody negative, Benign intracranial hypertension, Blood iron normal, Bronchitis, Computerised tomogram normal, CSF culture negative, CSF pressure increased, Decreased activity, Diplopia, Headache, Intracranial pressure increased, Lumbar puncture, Lumbar puncture abnormal, Muscle twitching, Nausea, Nuclear magnetic resonance imaging abnormal, Pain, Paraesthesia, Rash, Spinal X-ray normal, Thyroid function test normal, Urticaria, Vision blurred, Visual impairment, Vomiting, Bone scan normal, Brain scan normal, Metabolic function test normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 30     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: Bronchitis
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown ``02/15/10 LABS and DIAGNOSTICS: Ct-normal, MRI-abnormal (abnormal clivus), LP-abnormal (elevated opening pressure), CSF cult-neg., Bone scan-normal (no abnormality or bony lesion of the clivus), Three-view cervical spine x-ray-normal (no evidence of instability), Venography MR of brain- neg (congenitally small L. transverse & sigmoid sinuses[normal variant], No evidence of thrombosis or occlusion of sinuses of brain), Thyroid antibody thyroid function test-normal, Iron studies-normal, Vit A- WNL, ANA-neg., .
CDC 'Split Type': WAES1001USA03372

Write-up:Information has been received from a health professional concerning her daughter an 18 year old female who in October 2007, was vaccinated with the first dose of GARDASIL (lot number not reported). There were no pertinent medical history and drug reactions/allergies. Concomitant therapy included RECOMBIVAX HB (unspecified). The healthcare worker reported that her daughter developed "stabbing head pain associated with a twitch" in approximately October 2007 about 2 weeks after she received her first dose of GARDASIL. The patient had been diagnosed with pseudotumor cerebri which limited her physical activity and she was hospitalized. The patient''s pseudotumor cerebri persisted. The patient underwent lumbar puncture to relieve fluid pressure. Multiple unspecified blood tests and diagnostic studies were performed with results not report. Pseudotumor cerebri was considered to be disabling, immediately life-threatening and an other important medical event by the healthcare worker. Follow up information was received from a healthcare professional who reported the patient was vaccinated with the first dose of GARDASIL on 28-FEB-2007, the second dose of GARDASIL on 15-OCT-2007, and the third dose of GARDASIL on 01-JUL-2008 (lot numbers not reported). Concomitant vaccine included MENACTRA received on 28-FEB-2007 and VAQTA (unspecified) received on 28-FEB-2007 and 15-OCT-2007 (lot number not reported). At the 28-FEB-2007 office visit, the patient had bronchitis. At the 15-OCT-2007 office visit, there was no mention of any adverse event. On 23-OCT-2007, the patient was seen for hives and ZYRTEC was given. On 30-OCT-2007, the patient complained of pins and needles all over, rash was gone. On 28-NOV-2007, the patient complained of blurred vision, and a neuro consult was directed. In November and December 2007, the patient was admitted to the hospital (no other details available). In November 2008, the patient was admitted for nausea, vomiting and headache (no other details). On 05-JUN-2009, the patient was last seen in their office. Additional information has been requested.


Changed on 9/14/2017

379853 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:Florida
Vaccinated:2007-02-28
Onset:2007-10-01
Submitted:2010-02-05
Entered:2010-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1213F / - UNK UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0012U / 1 2 UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2562AA / - UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Benign intracranial hypertension, Bronchitis, CSF pressure increased, Decreased activity, Headache, Lumbar puncture, Muscle twitching, Nausea, Paraesthesia, Rash, Urticaria, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 30     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: Bronchitis
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown ``02/15/10 LABS and DIAGNOSTICS: Ct-normal, MRI-abnormal (abnormal clivus), LP-abnormal (elevated opening pressure), CSF cult-neg., Bone scan-normal (no abnormality or bony lesion of the clivus), Three-view cervical spine x-ray-normal (no evidence of instability), Venography MR of brain- neg (congenitally small L. transverse & sigmoid sinuses[normal variant], No evidence of thrombosis or occlusion of sinuses of brain), Thyroid antibody thyroid function test-normal, Iron studies-normal, Vit A- WNL, ANA-neg., .
CDC 'Split Type': WAES1001USA03372

Write-up:Information has been received from a health professional concerning her daughter an 18 year old female who in October 2007, was vaccinated with the first dose of GARDASIL (lot number not reported). There were no pertinent medical history and drug reactions/allergies. Concomitant therapy included RECOMBIVAX HB (unspecified). The healthcare worker reported that her daughter developed "stabbing head pain associated with a twitch" in approximately October 2007 about 2 weeks after she received her first dose of GARDASIL. The patient had been diagnosed with pseudotumor cerebri which limited her physical activity and she was hospitalized. The patient''s pseudotumor cerebri persisted. The patient underwent lumbar puncture to relieve fluid pressure. Multiple unspecified blood tests and diagnostic studies were performed with results not report. Pseudotumor cerebri was considered to be disabling, immediately life-threatening and an other important medical event by the healthcare worker. Follow up information was received from a healthcare professional who reported the patient was vaccinated with the first dose of GARDASIL on 28-FEB-2007, the second dose of GARDASIL on 15-OCT-2007, and the third dose of GARDASIL on 01-JUL-2008 (lot numbers not reported). Concomitant vaccine included MENACTRA received on 28-FEB-2007 and VAQTA (unspecified) received on 28-FEB-2007 and 15-OCT-2007 (lot number not reported). At the 28-FEB-2007 office visit, the patient had bronchitis. At the 15-OCT-2007 office visit, there was no mention of any adverse event. On 23-OCT-2007, the patient was seen for hives and ZYRTEC was given. On 30-OCT-2007, the patient complained of pins and needles all over, rash was gone. On 28-NOV-2007, the patient complained of blurred vision, and a neuro consult was directed. In November and December 2007, the patient was admitted to the hospital (no other details available). In November 2008, the patient was admitted for nausea, vomiting and headache (no other details). On 05-JUN-2009, the patient was last seen in their office. Additional information has been requested.


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