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This is VAERS ID 391817

History of Changes from the VAERS Wayback Machine

First Appeared on 7/31/2010

391817
VAERS Form:
Age:14.0
Gender:Female
Location:Oklahoma
Vaccinated:2007-02-05
Onset:2007-03-26
Submitted:2010-06-30
Entered:2010-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1208F / 0 AR / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1875AA / 0 AR / UN

Administered by: Public      Purchased by: Private
Symptoms: Dehydration, Fatigue, Hypothyroidism, Weight decreased, Type 1 diabetes mellitus

Life Threatening? Yes
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: 5     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: seasonal allergies
Allergies:
Diagnostic Lab Data: Doctor ran all tests and blood work.
CDC 'Split Type':

Write-up:Over a 3 week period patient lost 20 pounds, extremely tired, & dehydrated. On 3-26-07 she was diagnosed with Type 1 Diabetes and Hypothyroid. She was admitted with a 1075 blood sugar. No family history of Diabetes.


Changed on 8/31/2010

391817 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Oklahoma
Vaccinated:2007-02-05
Onset:2007-03-26
Submitted:2010-06-30
Entered:2010-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1208F / 0 AR / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1875AA / 0 AR / UN

Administered by: Public      Purchased by: Private
Symptoms: Dehydration, Fatigue, Hypothyroidism, Weight decreased, Blood test, Type 1 diabetes mellitus

Life Threatening? Yes
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: 5     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: seasonal allergies
Allergies:
Diagnostic Lab Data: Doctor ran all tests and blood work.
CDC 'Split Type':

Write-up:Over a 3 week period patient lost 20 pounds, extremely tired, & dehydrated. On 3-26-07 she was diagnosed with Type 1 Diabetes and Hypothyroid. She was admitted with a 1075 blood sugar. No family history of Diabetes.


Changed on 1/4/2011

391817 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Oklahoma
Vaccinated:2007-02-05
Onset:2007-03-26
Submitted:2010-06-30
Entered:2010-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1208F / 0 AR / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1875AA / 0 AR / UN

Administered by: Public      Purchased by: Private
Symptoms: Dehydration, Fatigue, Hypothyroidism, Weight decreased, Blood test, Type 1 diabetes mellitus

Life Threatening? Yes
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: 5     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: seasonal allergies
Allergies:
Diagnostic Lab Data: Doctor ran all tests and blood work.
CDC 'Split Type':

Write-up:Over a 3 week period patient lost 20 pounds, extremely tired, & dehydrated. On 3-26-07 she was diagnosed with Type 1 Diabetes and Hypothyroid. She was admitted with a 1075 blood sugar. No family history of Diabetes.


Changed on 4/13/2011

391817 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Oklahoma
Vaccinated:2007-02-05
Onset:2007-03-26
Submitted:2010-06-30
Entered:2010-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1208F / 0 AR / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1875AA / 0 AR / UN

Administered by: Public      Purchased by: Private
Symptoms: Blood glucose increased, Blood sodium decreased, Blood thyroid stimulating hormone increased, Dehydration, Fatigue, Feeling cold, Glucose urine present, Glycosylated haemoglobin increased, Hypothyroidism, Intensive care, Irritability, Lethargy, Metabolic acidosis, Thirst, Weight decreased, Urine ketone body present, Type 1 diabetes mellitus

Life Threatening? Yes
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: 5     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: seasonal allergies
Allergies:
Diagnostic Lab Data: Doctor ran all tests and blood work.
CDC 'Split Type':

Write-up:Over a 3 week period patient lost 20 pounds, extremely tired, & dehydrated. On 3-26-07 she was diagnosed with Type 1 Diabetes and Hypothyroid. She was admitted with a 1075 blood sugar. No family history of Diabetes.


Changed on 5/13/2011

391817 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Oklahoma
Vaccinated:2007-02-05
Onset:2007-03-26
Submitted:2010-06-30
Entered:2010-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1208F / 0 AR / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1875AA / 0 AR / UN

Administered by: Public      Purchased by: Private
Symptoms: Blood glucose increased, Blood sodium decreased, Blood thyroid stimulating hormone increased, Dehydration, Fatigue, Feeling cold, Glucose urine present, Glycosylated haemoglobin increased, Hypothyroidism, Intensive care, Irritability, Lethargy, Metabolic acidosis, Thirst, Weight decreased, Urine ketone body present, Type 1 diabetes mellitus

Life Threatening? Yes
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: 5     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: seasonal allergies
Allergies:
Diagnostic Lab Data: Doctor ran all tests and blood work.
CDC 'Split Type':

Write-up:Over a 3 week period patient lost 20 pounds, extremely tired, & dehydrated. On 3-26-07 she was diagnosed with Type 1 Diabetes and Hypothyroid. She was admitted with a 1075 blood sugar. No family history of Diabetes.


Changed on 6/11/2011

391817 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Oklahoma
Vaccinated:2007-02-05
Onset:2007-03-26
Submitted:2010-06-30
Entered:2010-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1208F / 0 AR / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1875AA / 0 AR / UN

Administered by: Public      Purchased by: Private
Symptoms: Blood glucose increased, Blood sodium decreased, Blood thyroid stimulating hormone increased, Dehydration, Fatigue, Feeling cold, Glucose urine present, Glycosylated haemoglobin increased, Hypothyroidism, Intensive care, Irritability, Lethargy, Metabolic acidosis, Thirst, Weight decreased, Urine ketone body present, Type 1 diabetes mellitus

Life Threatening? Yes
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: 5     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: seasonal allergies
Allergies:
Diagnostic Lab Data: Doctor ran all tests and blood work.
CDC 'Split Type':

Write-up:Over a 3 week period patient lost 20 pounds, extremely tired, & dehydrated. On 3-26-07 she was diagnosed with Type 1 Diabetes and Hypothyroid. She was admitted with a 1075 blood sugar. No family history of Diabetes.


Changed on 3/14/2015

391817 Before After
VAERS Form:
Age:14.0
Gender:Female
Location:Oklahoma
Vaccinated:2007-02-05
Onset:2007-03-26
Submitted:2010-06-30
Entered:2010-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1208F / 0 AR / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1875AA / 0 AR / UN

Administered by: Public      Purchased by: Private
Symptoms: Blood glucose increased, Blood sodium decreased, Blood thyroid stimulating hormone increased, Dehydration, Fatigue, Feeling cold, Glucose urine present, Glycosylated haemoglobin increased, Hypothyroidism, Intensive care, Irritability, Lethargy, Metabolic acidosis, Thirst, Weight decreased, Urine ketone body present, Type 1 diabetes mellitus

Life Threatening? Yes
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: 5     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: seasonal allergies
Allergies:
Diagnostic Lab Data: Doctor ran all tests and blood work.
CDC 'Split Type':

Write-up:Over a 3 week period patient lost 20 pounds, extremely tired, & dehydrated. On 3-26-07 she was diagnosed with Type 1 Diabetes and Hypothyroid. She was admitted with a 1075 blood sugar. No family history of Diabetes.


Changed on 9/14/2017

391817 Before After
VAERS Form:(blank) 1
Age:14.0
Gender:Female
Location:Oklahoma
Vaccinated:2007-02-05
Onset:2007-03-26
Submitted:2010-06-30
Entered:2010-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1208F / 0 1 AR / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1875AA / 0 1 AR / UN

Administered by: Public      Purchased by: Private
Symptoms: Dehydration, Fatigue, Hypothyroidism, Weight decreased, Type 1 diabetes mellitus

Life Threatening? Yes
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: 5     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: seasonal allergies
Allergies:
Diagnostic Lab Data: Doctor ran all tests and blood work.
CDC 'Split Type':

Write-up:Over a 3 week period patient lost 20 pounds, extremely tired, & dehydrated. On 3-26-07 she was diagnosed with Type 1 Diabetes and Hypothyroid. She was admitted with a 1075 blood sugar. No family history of Diabetes.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=391817&WAYBACKHISTORY=ON


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