National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 406578

History of Changes from the VAERS Wayback Machine

First Appeared on 11/3/2010

VAERS ID: 406578
Age:12.0
Gender:Female
Location:Michigan
Vaccinated:2010-05-12
Onset:2010-09-23
Submitted:2010-11-01
Entered:2010-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 0 UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / 0 UN / UN
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 5 UN / UN
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 UN / UN

Administered by: Public      Purchased by: Private
Symptoms: Alopecia, Arthritis, Dry eye, Epistaxis, Fatigue, Lethargy, Memory impairment, Multiple sclerosis, Sjogren's syndrome, Systemic lupus erythematosus, Antiphospholipid antibodies positive, Cognitive disorder, Antinuclear antibody positive, Autoimmune disorder

Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Autoimmune~HPV (Gardasil)~1~12.00~Patient|Autoimmune.~Varicella (no brand name)~UN~12.00~Patient
Other Medications: not at this time
Current Illness: none
Preexisting Conditions: eczema born - colic 3 wks old to 8 mos old
Diagnostic Lab Data: 10/18/2010 more lupus 1:320 positive ANA testing TBD 11/10/10
CDC 'Split Type':

Write-up:Memory and cognitive deficit May to present - Hair loss, nose bleeds, fatigue, lethargy, dry eyes, positive ANA test for an autoimmune Dx for either lupus, MS, arthritis and Sjorgrens Neuro Children''s hospital. Continues treatment.


Changed on 12/7/2010

VAERS ID: 406578 Before After
Age:12.0
Gender:Female
Location:Michigan
Vaccinated:2010-05-12
Onset:2010-09-23 2010-05-17
Submitted:2010-11-01
Entered:2010-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) HEP A (HAVRIX) / UNKNOWN MANUFACTURER GLAXOSMITHKLINE BIOLOGICALS - AHAVB365CA / 0 UN RA / UN IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - 0969Y / 0 UN LA / UN IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - U3068AA / 0 UN RA / UN IM
TDAP: TDAP (NO BRAND NAME) TDAP (ADACEL) / UNKNOWN MANUFACTURER SANOFI PASTEUR - U3052AA / 5 UN LA / UN IM
VARCEL: VARICELLA (NO BRAND NAME) VARICELLA (VARIVAX) / UNKNOWN MANUFACTURER MERCK & CO. INC. - 1048S / 1 UN LA / UN SC

Administered by: Public      Purchased by: Private
Symptoms: Alopecia, Arthritis, Dry eye, Epistaxis, Fatigue, Lethargy, Memory impairment, Multiple sclerosis, Sjogren's syndrome, Systemic lupus erythematosus, Antiphospholipid antibodies positive, Cognitive disorder, Antinuclear antibody positive, Autoimmune disorder

Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Autoimmune~HPV (Gardasil)~1~12.00~Patient|Autoimmune.~Varicella Autoimmune.~Varicella (no brand name)~UN~12.00~Patient name)~UN~12.00~Patient|Autoimmune~HPV (Gardasil)~1~12.00~Patient
Other Medications: not at this time
Current Illness: none
Preexisting Conditions: eczema born - colic 3 wks old to 8 mos old
Diagnostic Lab Data: 10/18/2010 more lupus 1:320 positive ANA testing TBD 11/10/10
CDC 'Split Type':

Write-up:Memory and cognitive deficit May to present - Hair loss, nose bleeds, fatigue, lethargy, dry eyes, positive ANA test for an autoimmune Dx for either lupus, MS, arthritis and Sjorgrens Neuro Children''s hospital. Continues treatment.


Changed on 4/13/2011

VAERS ID: 406578 Before After
Age:12.0
Gender:Female
Location:Michigan
Vaccinated:2010-05-12
Onset:2010-05-17
Submitted:2010-11-01
Entered:2010-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB365CA / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0969Y / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3068AA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U3052AA / 5 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1048S / 1 LA / SC

Administered by: Public      Purchased by: Private
Symptoms: Abdominal pain upper, Alopecia, Apathy, Arthralgia, Arthritis, Back pain, Blood immunoglobulin G normal, Blood immunoglobulin M, Blood thyroid stimulating hormone normal, Bone pain, Constipation, Culture throat negative, Culture urine positive, Decreased interest, Depression, Diarrhoea, Disturbance in attention, Dry eye, Electroencephalogram abnormal, Epistaxis, Eye pain, Fatigue, Feeling abnormal, Lethargy, Memory impairment, Mouth ulceration, Multiple sclerosis, Myalgia, Nausea, Neck pain, Neglect of personal appearance, Nuclear magnetic resonance imaging abnormal, Nuclear magnetic resonance imaging brain normal, Ocular hyperaemia, Pain, Pain in extremity, Rash, Sjogren's syndrome, Somnolence, Spinal X-ray normal, Systemic lupus erythematosus, Tenderness, Thirst, Urinary tract infection, Visual impairment, Vitamin B12 normal, Weight decreased, Weight increased, X-ray normal, Rheumatoid factor negative, Antiphospholipid antibodies positive, Myofascial pain syndrome, Red blood cell sedimentation rate normal, Contusion, Drug screen negative, Musculoskeletal stiffness, Epstein-Barr virus antibody negative, Temperature intolerance, Cognitive disorder, Russell's viper venom time abnormal, Antinuclear antibody positive, Anti-SS-A antibody negative, Anti-SS-B antibody negative, DNA antibody negative, Escherichia infection, Decreased appetite, Autoimmune disorder, Blood heavy metal normal, Urine analysis abnormal, Poor quality sleep, Keratosis pilaris, Decreased eye contact, Streptococcus test negative

Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Autoimmune.~Varicella (no brand name)~UN~12.00~Patient|Autoimmune~HPV (Gardasil)~1~12.00~Patient
Other Medications: not at this time
Current Illness: none
Preexisting Conditions: eczema born - colic 3 wks old to 8 mos old
Diagnostic Lab Data: 10/18/2010 more lupus 1:320 positive ANA testing TBD 11/10/10
CDC 'Split Type':

Write-up:Memory and cognitive deficit May to present - Hair loss, nose bleeds, fatigue, lethargy, dry eyes, positive ANA test for an autoimmune Dx for either lupus, MS, arthritis and Sjorgrens Neuro Children''s hospital. Continues treatment.


Changed on 5/13/2011

VAERS ID: 406578 Before After
Age:12.0
Gender:Female
Location:Michigan
Vaccinated:2010-05-12
Onset:2010-05-17
Submitted:2010-11-01
Entered:2010-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB365CA / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0969Y / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3068AA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U3052AA / 5 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1048S / 1 LA / SC

Administered by: Public      Purchased by: Private
Symptoms: Abdominal pain upper, Alopecia, Apathy, Arthralgia, Arthritis, Back pain, Blood immunoglobulin G normal, Blood immunoglobulin M, Blood thyroid stimulating hormone normal, Bone pain, Constipation, Culture throat negative, Culture urine positive, Decreased interest, Depression, Diarrhoea, Disturbance in attention, Dry eye, Electroencephalogram abnormal, Epistaxis, Eye pain, Fatigue, Feeling abnormal, Lethargy, Memory impairment, Mouth ulceration, Multiple sclerosis, Myalgia, Nausea, Neck pain, Neglect of personal appearance, Nuclear magnetic resonance imaging abnormal, Nuclear magnetic resonance imaging brain normal, Ocular hyperaemia, Pain, Pain in extremity, Rash, Sjogren's syndrome, Somnolence, Spinal X-ray normal, Systemic lupus erythematosus, Tenderness, Thirst, Urinary tract infection, Visual impairment, Vitamin B12 normal, Weight decreased, Weight increased, X-ray normal, Rheumatoid factor negative, Antiphospholipid antibodies positive, Myofascial pain syndrome, Red blood cell sedimentation rate normal, Contusion, Drug screen negative, Musculoskeletal stiffness, Epstein-Barr virus antibody negative, Temperature intolerance, Cognitive disorder, Russell's viper venom time abnormal, Antinuclear antibody positive, Anti-SS-A antibody negative, Anti-SS-B antibody negative, DNA antibody negative, Escherichia infection, Decreased appetite, Autoimmune disorder, Blood heavy metal normal, Urine analysis abnormal, Poor quality sleep, Keratosis pilaris, Decreased eye contact, Streptococcus test negative

Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Autoimmune.~Varicella (no brand name)~UN~12.00~Patient|Autoimmune~HPV (Gardasil)~1~12.00~Patient
Other Medications: not at this time
Current Illness: none
Preexisting Conditions: eczema born - colic 3 wks old to 8 mos old
Diagnostic Lab Data: 10/18/2010 more lupus 1:320 positive ANA testing TBD 11/10/10
CDC 'Split Type':

Write-up:Memory and cognitive deficit May to present - Hair loss, nose bleeds, fatigue, lethargy, dry eyes, positive ANA test for an autoimmune Dx for either lupus, MS, arthritis and Sjorgrens Neuro Children''s hospital. Continues treatment.


Changed on 1/7/2013

VAERS ID: 406578 Before After
Age:12.0
Gender:Female
Location:Michigan
Vaccinated:2010-05-12
Onset:2010-05-17
Submitted:2010-11-01
Entered:2010-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB365CA / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0969Y / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3068AA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U3052AA / 5 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1048S / 1 LA / SC

Administered by: Public      Purchased by: Private
Symptoms: Alopecia, Arthritis, Dry eye, Epistaxis, Fatigue, Lethargy, Memory impairment, Multiple sclerosis, Sjogren's syndrome, Systemic lupus erythematosus, Antiphospholipid antibodies positive, Cognitive disorder, Antinuclear antibody positive, Autoimmune disorder

Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Autoimmune.~Varicella (no brand name)~UN~12.00~Patient|Autoimmune~HPV (Gardasil)~1~12.00~Patient
Other Medications: not at this time
Current Illness: none
Preexisting Conditions: eczema born - colic 3 wks old to 8 mos old
Diagnostic Lab Data: 10/18/2010 more lupus 1:320 positive ANA testing TBD 11/10/10
CDC 'Split Type':

Write-up:Memory and cognitive deficit May to present - Hair loss, nose bleeds, fatigue, lethargy, dry eyes, positive ANA test for an autoimmune Dx for either lupus, MS, arthritis and Sjorgrens Neuro Children''s hospital. Continues treatment.


Changed on 2/13/2013

VAERS ID: 406578 Before After
Age:12.0
Gender:Female
Location:Michigan
Vaccinated:2010-05-12
Onset:2010-05-17
Submitted:2010-11-01
Entered:2010-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB365CA / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0969Y / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3068AA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U3052AA / 5 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1048S / 1 LA / SC

Administered by: Public      Purchased by: Private
Symptoms: Alopecia, Arthritis, Dry eye, Epistaxis, Fatigue, Lethargy, Memory impairment, Multiple sclerosis, Sjogren's syndrome, Systemic lupus erythematosus, Antiphospholipid antibodies positive, Cognitive disorder, Antinuclear antibody positive, Autoimmune disorder

Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Autoimmune.~Varicella (no brand name)~UN~12.00~Patient|Autoimmune~HPV (Gardasil)~1~12.00~Patient
Other Medications: not at this time
Current Illness: none
Preexisting Conditions: eczema born - colic 3 wks old to 8 mos old
Diagnostic Lab Data: 10/18/2010 more lupus 1:320 positive ANA testing TBD 11/10/10
CDC 'Split Type':

Write-up:Memory and cognitive deficit May to present - Hair loss, nose bleeds, fatigue, lethargy, dry eyes, positive ANA test for an autoimmune Dx for either lupus, MS, arthritis and Sjorgrens Dr - neuro hospital. Continues treatment.


Changed on 3/14/2014

VAERS ID: 406578 Before After
Age:12.0
Gender:Female
Location:Michigan
Vaccinated:2010-05-12
Onset:2010-05-17
Submitted:2010-11-01
Entered:2010-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB365CA / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0969Y / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3068AA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U3052AA / 5 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1048S / 1 LA / SC

Administered by: Public      Purchased by: Private
Symptoms: Alopecia, Arthritis, Dry eye, Epistaxis, Fatigue, Lethargy, Memory impairment, Multiple sclerosis, Sjogren's syndrome, Systemic lupus erythematosus, Antiphospholipid antibodies positive, Cognitive disorder, Antinuclear antibody positive, Autoimmune disorder

Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Autoimmune.~Varicella Autoimmune~HPV (Gardasil)~1~12.00~Patient|Autoimmune.~Varicella (no brand name)~UN~12.00~Patient|Autoimmune~HPV (Gardasil)~1~12.00~Patient name)~UN~12.00~Patient
Other Medications: not at this time
Current Illness: none
Preexisting Conditions: eczema born - colic 3 wks old to 8 mos old
Diagnostic Lab Data: 10/18/2010 more lupus 1:320 positive ANA testing TBD 11/10/10
CDC 'Split Type':

Write-up:Memory and cognitive deficit May to present - Hair loss, nose bleeds, fatigue, lethargy, dry eyes, positive ANA test for an autoimmune Dx for either lupus, MS, arthritis and Sjorgrens Dr - neuro hospital. Continues treatment.


Changed on 6/14/2014

VAERS ID: 406578 Before After
Age:12.0
Gender:Female
Location:Michigan
Vaccinated:2010-05-12
Onset:2010-05-17
Submitted:2010-11-01
Entered:2010-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB365CA / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0969Y / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3068AA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U3052AA / 5 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1048S / 1 LA / SC

Administered by: Public      Purchased by: Private
Symptoms: Alopecia, Arthritis, Dry eye, Epistaxis, Fatigue, Lethargy, Memory impairment, Multiple sclerosis, Sjogren's syndrome, Systemic lupus erythematosus, Antiphospholipid antibodies positive, Cognitive disorder, Antinuclear antibody positive, Autoimmune disorder

Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Autoimmune~HPV (Gardasil)~1~12.00~Patient|Autoimmune.~Varicella (no brand name)~UN~12.00~Patient
Other Medications: not at this time
Current Illness: none
Preexisting Conditions: eczema born - colic 3 wks old to 8 mos old
Diagnostic Lab Data: 10/18/2010 more lupus 1:320 positive ANA testing TBD 11/10/10
CDC 'Split Type':

Write-up:Memory and cognitive deficit May to present - Hair loss, nose bleeds, fatigue, lethargy, dry eyes, positive ANA test for an autoimmune Dx for either lupus, MS, arthritis and Sjorgrens Dr - neuro hospital. Continues treatment.


Changed on 3/14/2015

VAERS ID: 406578 Before After
Age:12.0
Gender:Female
Location:Michigan
Vaccinated:2010-05-12
Onset:2010-05-17
Submitted:2010-11-01
Entered:2010-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB365CA / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0969Y / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3068AA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U3052AA / 5 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1048S / 1 LA / SC

Administered by: Public      Purchased by: Private
Symptoms: Alopecia, Arthritis, Dry eye, Epistaxis, Fatigue, Lethargy, Memory impairment, Multiple sclerosis, Sjogren's syndrome, Systemic lupus erythematosus, Antiphospholipid antibodies positive, Cognitive disorder, Antinuclear antibody positive, Autoimmune disorder

Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Autoimmune~HPV (Gardasil)~1~12.00~Patient|Autoimmune.~Varicella (no brand name)~UN~12.00~Patient
Other Medications: not at this time
Current Illness: none
Preexisting Conditions: eczema born - colic 3 wks old to 8 mos old
Diagnostic Lab Data: 10/18/2010 more lupus 1:320 positive ANA testing TBD 11/10/10
CDC 'Split Type':

Write-up:Memory and cognitive deficit May to present - Hair loss, nose bleeds, fatigue, lethargy, dry eyes, positive ANA test for an autoimmune Dx for either lupus, MS, arthritis and Sjorgrens Dr - neuro hospital. Continues treatment.


Changed on 4/14/2017

VAERS ID: 406578 Before After
Age:12.0
Gender:Female
Location:Michigan
Vaccinated:2010-05-12
Onset:2010-05-17
Submitted:2010-11-01
Entered:2010-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB365CA / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0969Y / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3068AA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U3052AA / 5 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1048S / 1 LA / SC

Administered by: Public      Purchased by: Private
Symptoms: Alopecia, Arthritis, Dry eye, Epistaxis, Fatigue, Lethargy, Memory impairment, Multiple sclerosis, Sjogren's syndrome, Systemic lupus erythematosus, Antiphospholipid antibodies positive, Cognitive disorder, Antinuclear antibody positive, Autoimmune disorder

Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Autoimmune~HPV (Gardasil)~1~12.00~Patient|Autoimmune.~Varicella Autoimmune.~Varicella (no brand name)~UN~12.00~Patient name)~UN~12.00~Patient|Autoimmune~HPV (Gardasil)~1~12.00~Patient
Other Medications: not at this time
Current Illness: none
Preexisting Conditions: eczema born - colic 3 wks old to 8 mos old
Diagnostic Lab Data: 10/18/2010 more lupus 1:320 positive ANA testing TBD 11/10/10
CDC 'Split Type':

Write-up:Memory and cognitive deficit May to present - Hair loss, nose bleeds, fatigue, lethargy, dry eyes, positive ANA test for an autoimmune Dx for either lupus, MS, arthritis and Sjorgrens Dr - neuro hospital. Continues treatment.


New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=406578&WAYBACKHISTORY=ON


Copyright © 2017 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166