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This is VAERS ID 451058

History of Changes from the VAERS Wayback Machine

First Appeared on 3/12/2012

451058
VAERS Form:
Age:14.0
Gender:Male
Location:New Jersey
Vaccinated:2011-10-27
Onset:2012-02-01
Submitted:2012-03-02
Entered:2012-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1359AA / 0 RA / UN

Administered by: Other      Purchased by: Other
Symptoms: Electroencephalogram, Loss of consciousness, Memory impairment, Mood altered, Paraesthesia, Activities of daily living impaired, Cognitive disorder, Vaccine positive rechallenge

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: None
Current Illness:
Preexisting Conditions: Convulsion
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1202USA04136

Write-up:Information has been received from a consumer concerning her 15 year old son with a history of seizure who on 27-OCT-2011 was vaccinated with first dose of GARDASIL. On 03-FEB-2012 patient was vaccinated with second dose (lot #, route and site were not reported for both doses). There was no concomitant medication. At an unspecified time period after his first dose, her son started to experience tingling in his legs and "moody behavior". Her son was administered his second dose on 03-FEB-2012 and at an unspecified time period experienced tingling in his legs and his short term memory was "bad". Her son also experienced "blackouts". On 14-FEB-2012 her son''s teacher sent a letter home to say that he was not grasping concepts at school. Her son had been out of school since 14-FEB-2012. Her son was referred by his primary care Physician. The mother called to office and her son was seen by neurologist. No treatment was given for the adverse event. Two Electroencephalo-graphs (EEG) were performed in which the results were pending. Her son would not be receiving his third dose. At the time of this report, the patient had not recovered from above events. Action taken with GARDASIL was discontinued. Short-term memory impairment, moody behavior, not grasping concepts in school, Loss of consciousness and tingling in his legs which made patient out of school for half a month were considered to be disabling. Additional information has been requested.


Changed on 7/7/2013

451058 Before After
VAERS Form:
Age:14.0
Gender:Male
Location:New Jersey
Vaccinated:2011-10-27
Onset:2012-02-01
Submitted:2012-03-02
Entered:2012-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / - UN / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1359AA / 0 RA / UN

Administered by: Other      Purchased by: Other
Symptoms: Electroencephalogram, Loss of consciousness, Memory impairment, Mood altered, Paraesthesia, Activities of daily living impaired, Cognitive disorder, Vaccine positive rechallenge

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: None
Current Illness:
Preexisting Conditions: Convulsion
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1202USA04136

Write-up:Information has been received from a consumer concerning her 15 year old son with a history of seizure who on 27-OCT-2011 was vaccinated with first dose of GARDASIL. On 03-FEB-2012 patient was vaccinated with second dose (lot #, route and site were not reported for both doses). There was no concomitant medication. At an unspecified time period after his first dose, her son started to experience tingling in his legs and "moody behavior". Her son was administered his second dose on 03-FEB-2012 and at an unspecified time period experienced tingling in his legs and his short term memory was "bad". Her son also experienced "blackouts". On 14-FEB-2012 her son''s teacher sent a letter home to say that he was not grasping concepts at school. Her son had been out of school since 14-FEB-2012. Her son was referred by his primary care Physician. The mother called to office and her son was seen by neurologist. No treatment was given for the adverse event. Two Electroencephalo-graphs (EEG) were performed in which the results were pending. Her son would not be receiving his third dose. At the time of this report, the patient had not recovered from above events. Action taken with GARDASIL was discontinued. Short-term memory impairment, moody behavior, not grasping concepts in school, Loss of consciousness and tingling in his legs which made patient out of school for half a month were considered to be disabling. Additional information has been requested.


Changed on 6/14/2014

451058 Before After
VAERS Form:
Age:14.0
Gender:Male
Location:New Jersey
Vaccinated:2011-10-27
Onset:2012-02-01
Submitted:2012-03-02
Entered:2012-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1359AA / 0 RA / UN

Administered by: Other      Purchased by: Other
Symptoms: Electroencephalogram, Loss of consciousness, Memory impairment, Mood altered, Paraesthesia, Activities of daily living impaired, Cognitive disorder, Vaccine positive rechallenge

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: None
Current Illness:
Preexisting Conditions: Convulsion
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1202USA04136

Write-up:Information has been received from a consumer concerning her 15 year old son with a history of seizure who on 27-OCT-2011 was vaccinated with first dose of GARDASIL. On 03-FEB-2012 patient was vaccinated with second dose (lot #, route and site were not reported for both doses). There was no concomitant medication. At an unspecified time period after his first dose, her son started to experience tingling in his legs and "moody behavior". Her son was administered his second dose on 03-FEB-2012 and at an unspecified time period experienced tingling in his legs and his short term memory was "bad". Her son also experienced "blackouts". On 14-FEB-2012 her son''s teacher sent a letter home to say that he was not grasping concepts at school. Her son had been out of school since 14-FEB-2012. Her son was referred by his primary care Physician. The mother called to office and her son was seen by neurologist. No treatment was given for the adverse event. Two Electroencephalo-graphs (EEG) were performed in which the results were pending. Her son would not be receiving his third dose. At the time of this report, the patient had not recovered from above events. Action taken with GARDASIL was discontinued. Short-term memory impairment, moody behavior, not grasping concepts in school, Loss of consciousness and tingling in his legs which made patient out of school for half a month were considered to be disabling. Additional information has been requested.


Changed on 3/14/2015

451058 Before After
VAERS Form:
Age:14.0
Gender:Male
Location:New Jersey
Vaccinated:2011-10-27
Onset:2012-02-01
Submitted:2012-03-02
Entered:2012-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1359AA / 0 RA / UN

Administered by: Other      Purchased by: Other
Symptoms: Electroencephalogram, Loss of consciousness, Memory impairment, Mood altered, Paraesthesia, Activities of daily living impaired, Cognitive disorder, Vaccine positive rechallenge

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: None
Current Illness:
Preexisting Conditions: Convulsion
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1202USA04136

Write-up:Information has been received from a consumer concerning her 15 year old son with a history of seizure who on 27-OCT-2011 was vaccinated with first dose of GARDASIL. On 03-FEB-2012 patient was vaccinated with second dose (lot #, route and site were not reported for both doses). There was no concomitant medication. At an unspecified time period after his first dose, her son started to experience tingling in his legs and "moody behavior". Her son was administered his second dose on 03-FEB-2012 and at an unspecified time period experienced tingling in his legs and his short term memory was "bad". Her son also experienced "blackouts". On 14-FEB-2012 her son''s teacher sent a letter home to say that he was not grasping concepts at school. Her son had been out of school since 14-FEB-2012. Her son was referred by his primary care Physician. The mother called to office and her son was seen by neurologist. No treatment was given for the adverse event. Two Electroencephalo-graphs (EEG) were performed in which the results were pending. Her son would not be receiving his third dose. At the time of this report, the patient had not recovered from above events. Action taken with GARDASIL was discontinued. Short-term memory impairment, moody behavior, not grasping concepts in school, Loss of consciousness and tingling in his legs which made patient out of school for half a month were considered to be disabling. Additional information has been requested.


Changed on 9/14/2017

451058 Before After
VAERS Form:(blank) 1
Age:14.0
Gender:Male
Location:New Jersey
Vaccinated:2011-10-27
Onset:2012-02-01
Submitted:2012-03-02
Entered:2012-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / - UNK UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1359AA / 0 1 RA / UN

Administered by: Other      Purchased by: Other
Symptoms: Electroencephalogram, Loss of consciousness, Memory impairment, Mood altered, Paraesthesia, Activities of daily living impaired, Cognitive disorder, Vaccine positive rechallenge

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: None
Current Illness:
Preexisting Conditions: Convulsion
Allergies:
Diagnostic Lab Data: Unknown
CDC 'Split Type': WAES1202USA04136

Write-up:Information has been received from a consumer concerning her 15 year old son with a history of seizure who on 27-OCT-2011 was vaccinated with first dose of GARDASIL. On 03-FEB-2012 patient was vaccinated with second dose (lot #, route and site were not reported for both doses). There was no concomitant medication. At an unspecified time period after his first dose, her son started to experience tingling in his legs and "moody behavior". Her son was administered his second dose on 03-FEB-2012 and at an unspecified time period experienced tingling in his legs and his short term memory was "bad". Her son also experienced "blackouts". On 14-FEB-2012 her son''s teacher sent a letter home to say that he was not grasping concepts at school. Her son had been out of school since 14-FEB-2012. Her son was referred by his primary care Physician. The mother called to office and her son was seen by neurologist. No treatment was given for the adverse event. Two Electroencephalo-graphs (EEG) were performed in which the results were pending. Her son would not be receiving his third dose. At the time of this report, the patient had not recovered from above events. Action taken with GARDASIL was discontinued. Short-term memory impairment, moody behavior, not grasping concepts in school, Loss of consciousness and tingling in his legs which made patient out of school for half a month were considered to be disabling. Additional information has been requested.


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