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This is VAERS ID 442843

History of Changes from the VAERS Wayback Machine

First Appeared on 12/14/2011

442843
VAERS Form:
Age:11.0
Gender:Female
Location:Texas
Vaccinated:2009-09-29
Onset:2009-10-06
Submitted:2011-11-16
Entered:2011-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0100Y / 0 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Migraine

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications: PERIACTIN
Current Illness:
Preexisting Conditions: Lyme disease
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1107USA03591

Write-up:Information has been received from a physician concerning a 11 year old female patient with a history of positive for lyme disease who on 29-SEP-2009, was vaccinated with the first dose of GARDASIL (lot # 562300/0100Y, expiration date: 19-APR-2011) (dose and site of administration not reported) and in December 2009, the patient was vaccinated with the second dose of GARDASIL (lot number, dose and site of administration not reported). Concomitant therapy included cyproheptadine hydrochloride and diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid vaccine. On unspecified date, the patient started experiencing migraines after GARDASIL administration which then subsided after a month and came back after a second dose in December 2009. The patient sought unspecified medical attention. No treatment was given for the treatment of the adverse event. At the time of the report, the patient had not recovered. Follow up information has been received from a health care professional concerning the female student patient with no pre-existing allergies, birth defects, medical conditions or illness at time of vaccination who on 01-DEC-2009, at 16:03, was vaccinated intramuscularly with the second dose of GARDASIL (lot number: 662724/0313Y). On 06-OCT-2009, at 14:57, the patient experienced migraines. At the time of this report, migraines were ongoing. Laboratories and a computed axial tomography were recommended. The patient was also referred with a neurologist. The patient sought unspecified medical attention. Migraines were considered to be disabling by the reporter. Additional information has been requested.


Changed on 6/14/2014

442843 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:Texas
Vaccinated:2009-09-29
Onset:2009-10-06
Submitted:2011-11-16
Entered:2011-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0100Y / 0 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Migraine

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications: PERIACTIN
Current Illness:
Preexisting Conditions: Lyme disease
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1107USA03591

Write-up:Information has been received from a physician concerning a 11 year old female patient with a history of positive for lyme disease who on 29-SEP-2009, was vaccinated with the first dose of GARDASIL (lot # 562300/0100Y, expiration date: 19-APR-2011) (dose and site of administration not reported) and in December 2009, the patient was vaccinated with the second dose of GARDASIL (lot number, dose and site of administration not reported). Concomitant therapy included cyproheptadine hydrochloride and diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid vaccine. On unspecified date, the patient started experiencing migraines after GARDASIL administration which then subsided after a month and came back after a second dose in December 2009. The patient sought unspecified medical attention. No treatment was given for the treatment of the adverse event. At the time of the report, the patient had not recovered. Follow up information has been received from a health care professional concerning the female student patient with no pre-existing allergies, birth defects, medical conditions or illness at time of vaccination who on 01-DEC-2009, at 16:03, was vaccinated intramuscularly with the second dose of GARDASIL (lot number: 662724/0313Y). On 06-OCT-2009, at 14:57, the patient experienced migraines. At the time of this report, migraines were ongoing. Laboratories and a computed axial tomography were recommended. The patient was also referred with a neurologist. The patient sought unspecified medical attention. Migraines were considered to be disabling by the reporter. Additional information has been requested.


Changed on 4/14/2017

442843 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:Texas
Vaccinated:2009-09-29
Onset:2009-10-06
Submitted:2011-11-16
Entered:2011-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0100Y / 0 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Migraine

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications: PERIACTIN
Current Illness:
Preexisting Conditions: Lyme disease
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1107USA03591

Write-up:Information has been received from a physician concerning a 11 year old female patient with a history of positive for lyme disease who on 29-SEP-2009, was vaccinated with the first dose of GARDASIL (lot # 562300/0100Y, expiration date: 19-APR-2011) (dose and site of administration not reported) and in December 2009, the patient was vaccinated with the second dose of GARDASIL (lot number, dose and site of administration not reported). Concomitant therapy included cyproheptadine hydrochloride and diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid vaccine. On unspecified date, the patient started experiencing migraines after GARDASIL administration which then subsided after a month and came back after a second dose in December 2009. The patient sought unspecified medical attention. No treatment was given for the treatment of the adverse event. At the time of the report, the patient had not recovered. Follow up information has been received from a health care professional concerning the female student patient with no pre-existing allergies, birth defects, medical conditions or illness at time of vaccination who on 01-DEC-2009, at 16:03, was vaccinated intramuscularly with the second dose of GARDASIL (lot number: 662724/0313Y). On 06-OCT-2009, at 14:57, the patient experienced migraines. At the time of this report, migraines were ongoing. Laboratories and a computed axial tomography were recommended. The patient was also referred with a neurologist. The patient sought unspecified medical attention. Migraines were considered to be disabling by the reporter. Additional information has been requested.


Changed on 9/14/2017

442843 Before After
VAERS Form:(blank) 1
Age:11.0
Gender:Female
Location:Texas
Vaccinated:2009-09-29
Onset:2009-10-06
Submitted:2011-11-16
Entered:2011-11-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0100Y / 0 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Migraine

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications: PERIACTIN
Current Illness:
Preexisting Conditions: Lyme disease
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1107USA03591

Write-up:Information has been received from a physician concerning a 11 year old female patient with a history of positive for lyme disease who on 29-SEP-2009, was vaccinated with the first dose of GARDASIL (lot # 562300/0100Y, expiration date: 19-APR-2011) (dose and site of administration not reported) and in December 2009, the patient was vaccinated with the second dose of GARDASIL (lot number, dose and site of administration not reported). Concomitant therapy included cyproheptadine hydrochloride and diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid vaccine. On unspecified date, the patient started experiencing migraines after GARDASIL administration which then subsided after a month and came back after a second dose in December 2009. The patient sought unspecified medical attention. No treatment was given for the treatment of the adverse event. At the time of the report, the patient had not recovered. Follow up information has been received from a health care professional concerning the female student patient with no pre-existing allergies, birth defects, medical conditions or illness at time of vaccination who on 01-DEC-2009, at 16:03, was vaccinated intramuscularly with the second dose of GARDASIL (lot number: 662724/0313Y). On 06-OCT-2009, at 14:57, the patient experienced migraines. At the time of this report, migraines were ongoing. Laboratories and a computed axial tomography were recommended. The patient was also referred with a neurologist. The patient sought unspecified medical attention. Migraines were considered to be disabling by the reporter. Additional information has been requested.


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