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This is VAERS ID 397983

History of Changes from the VAERS Wayback Machine

First Appeared on 9/22/2010

397983
VAERS Form:
Age:18.0
Gender:Male
Location:Washington
Vaccinated:2010-07-16
Onset:2010-08-20
Submitted:2010-09-12
Entered:2010-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / IJ
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / IJ
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 5 UN / IJ

Administered by: Unknown      Purchased by: Other
Symptoms: Abdominal pain upper, Fatigue, Mononucleosis heterophile test negative, Urine analysis normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: Chylindamycin Topical Solution
Current Illness: May not be correct on date administered, but am close. I was not ill at all at time of administration.
Preexisting Conditions: None; completely healthy.
Allergies:
Diagnostic Lab Data: urine test (all normal) , test for mono (negative), colon not guarded, no inflammation of splean or colon or appendix.
CDC 'Split Type':

Write-up:Extreme fatigue, spontaneous stomach pain (followed up with doctor and on 9/11/10 with ER - all blood work and urine confirmed no infection); the gardisil vaccine was the only thing different that has occured in my life. ER gave antispasm prescription and has sent me back to primary care doctor.


Changed on 5/13/2011

397983 Before After
VAERS Form:
Age:18.0
Gender:Male
Location:Washington
Vaccinated:2010-07-16
Onset:2010-08-20
Submitted:2010-09-12
Entered:2010-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / IJ
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / IJ
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 5 UN / IJ

Administered by: Unknown      Purchased by: Other
Symptoms: Abdominal pain upper, Fatigue, Mononucleosis heterophile test negative, Urine analysis normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: Chylindamycin Clindamycin Topical Solution
Current Illness: May not be correct on date administered, but am close. I was not ill at all at time of administration.
Preexisting Conditions: None; completely healthy.
Allergies:
Diagnostic Lab Data: urine test (all normal) , normal), test for mono (negative), colon not guarded, no inflammation of splean spleen or colon or appendix.
CDC 'Split Type':

Write-up:Extreme fatigue, spontaneous stomach pain (followed up with doctor and on 9/11/10 with ER - all blood work and urine confirmed no infection); the gardisil Gardasil vaccine was the only thing different that has occured occurred in my life. ER gave antispasm prescription and has sent me back to primary care doctor.


Changed on 6/14/2014

397983 Before After
VAERS Form:
Age:18.0
Gender:Male
Location:Washington
Vaccinated:2010-07-16
Onset:2010-08-20
Submitted:2010-09-12
Entered:2010-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / IJ
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / IJ
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 5 UN / IJ

Administered by: Unknown      Purchased by: Other
Symptoms: Abdominal pain upper, Fatigue, Mononucleosis heterophile test negative, Urine analysis normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: Clindamycin Topical Solution
Current Illness: May not be correct on date administered, but am close. I was not ill at all at time of administration.
Preexisting Conditions: None; completely healthy.
Allergies:
Diagnostic Lab Data: urine test (all normal), test for mono (negative), colon not guarded, no inflammation of spleen or colon or appendix.
CDC 'Split Type':

Write-up:Extreme fatigue, spontaneous stomach pain (followed up with doctor and on 9/11/10 with ER - all blood work and urine confirmed no infection); the Gardasil vaccine was the only thing different that has occurred in my life. ER gave antispasm prescription and has sent me back to primary care doctor.


Changed on 4/14/2017

397983 Before After
VAERS Form:
Age:18.0
Gender:Male
Location:Washington
Vaccinated:2010-07-16
Onset:2010-08-20
Submitted:2010-09-12
Entered:2010-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / IJ
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / IJ
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 5 UN / IJ

Administered by: Unknown      Purchased by: Other
Symptoms: Abdominal pain upper, Fatigue, Mononucleosis heterophile test negative, Urine analysis normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: Clindamycin Topical Solution
Current Illness: May not be correct on date administered, but am close. I was not ill at all at time of administration.
Preexisting Conditions: None; completely healthy.
Allergies:
Diagnostic Lab Data: urine test (all normal), test for mono (negative), colon not guarded, no inflammation of spleen or colon or appendix.
CDC 'Split Type':

Write-up:Extreme fatigue, spontaneous stomach pain (followed up with doctor and on 9/11/10 with ER - all blood work and urine confirmed no infection); the Gardasil vaccine was the only thing different that has occurred in my life. ER gave antispasm prescription and has sent me back to primary care doctor.


Changed on 9/14/2017

397983 Before After
VAERS Form:(blank) 1
Age:18.0
Gender:Male
Location:Washington
Vaccinated:2010-07-16
Onset:2010-08-20
Submitted:2010-09-12
Entered:2010-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 1 UN / IJ
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 1 UN / IJ
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 5 6 UN / IJ

Administered by: Unknown      Purchased by: Other
Symptoms: Abdominal pain upper, Fatigue, Mononucleosis heterophile test negative, Urine analysis normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: Clindamycin Topical Solution
Current Illness: May not be correct on date administered, but am close. I was not ill at all at time of administration.
Preexisting Conditions: None; completely healthy.
Allergies:
Diagnostic Lab Data: urine test (all normal), test for mono (negative), colon not guarded, no inflammation of spleen or colon or appendix.
CDC 'Split Type':

Write-up:Extreme fatigue, spontaneous stomach pain (followed up with doctor and on 9/11/10 with ER - all blood work and urine confirmed no infection); the Gardasil vaccine was the only thing different that has occurred in my life. ER gave antispasm prescription and has sent me back to primary care doctor.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=397983&WAYBACKHISTORY=ON


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