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This is VAERS ID 456857

History of Changes from the VAERS Wayback Machine

First Appeared on 6/13/2012

456857
VAERS Form:
Age:11.0
Gender:Female
Location:Oregon
Vaccinated:2007-12-05
Onset:2008-07-01
Submitted:2012-06-01
Entered:2012-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 500576P / 0 - / IN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1063U / 0 AR / SYR

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain upper, Back pain, Blindness, Convulsion, Gene mutation identification test

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: 54     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Gene mutation Polg.
CDC 'Split Type':

Write-up:GARDASIL vaccine giving 12/5/07 and second injection 3/5/08. Chronic stomach pain noted for several months. Dr seen 10/24/08 for stomach pain. 3rd GARDASIL shot giving 11/12/08. Chronic stomach pain continues medical involvement continues for stomach pain. Patient seen 5/09 for severe back pain. Stomach pain continues until April 6, 2010 when patient stricken with seizures, hospitalization, blindness.


Changed on 7/7/2013

456857 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:Oregon
Vaccinated:2007-12-05
Onset:2008-07-01
Submitted:2012-06-01
Entered:2012-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 500576P / 0 - / IN
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 500576P / 0 - / IN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1063U / 0 AR / SYR

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain upper, Back pain, Blindness, Convulsion, Gene mutation identification test

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: 54     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Gene mutation Polg.
CDC 'Split Type':

Write-up:GARDASIL vaccine giving 12/5/07 and second injection 3/5/08. Chronic stomach pain noted for several months. Dr seen 10/24/08 for stomach pain. 3rd GARDASIL shot giving 11/12/08. Chronic stomach pain continues medical involvement continues for stomach pain. Patient seen 5/09 for severe back pain. Stomach pain continues until April 6, 2010 when patient stricken with seizures, hospitalization, blindness.


Changed on 6/14/2014

456857 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:Oregon
Vaccinated:2007-12-05
Onset:2008-07-01
Submitted:2012-06-01
Entered:2012-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 500576P / 0 - / IN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1063U / 0 AR / SYR

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain upper, Back pain, Blindness, Convulsion, Gene mutation identification test

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: 54     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Gene mutation Polg.
CDC 'Split Type':

Write-up:GARDASIL vaccine giving 12/5/07 and second injection 3/5/08. Chronic stomach pain noted for several months. Dr seen 10/24/08 for stomach pain. 3rd GARDASIL shot giving 11/12/08. Chronic stomach pain continues medical involvement continues for stomach pain. Patient seen 5/09 for severe back pain. Stomach pain continues until April 6, 2010 when patient stricken with seizures, hospitalization, blindness.


Changed on 7/14/2014

456857 Before After
VAERS Form:
Age:11.0
Gender:Female
Location:Oregon
Vaccinated:2007-12-05
Onset:2008-07-01
Submitted:2012-06-01
Entered:2012-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 500576P / 0 - / IN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1063U / 0 AR / SYR

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain upper, Back pain, Blindness, Convulsion, Gene mutation identification test

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: 54     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Gene mutation Polg.
CDC 'Split Type':

Write-up:GARDASIL vaccine giving 12/5/07 and second injection 3/5/08. Chronic stomach pain noted for several months. Dr seen 10/24/08 for stomach pain. 3rd GARDASIL shot giving 11/12/08. Chronic stomach pain continues medical involvement continues for stomach pain. Patient seen 5/09 for severe back pain. Stomach pain continues until April 6, 2010 when patient stricken with seizures, hospitalization, blindness.


Changed on 9/14/2017

456857 Before After
VAERS Form:(blank) 1
Age:11.0
Gender:Female
Location:Oregon
Vaccinated:2007-12-05
Onset:2008-07-01
Submitted:2012-06-01
Entered:2012-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 500576P / 0 1 - NS / IN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1063U / 0 1 AR / SYR

Administered by: Private      Purchased by: Private
Symptoms: Abdominal pain upper, Back pain, Blindness, Convulsion, Gene mutation identification test

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: 54     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Gene mutation Polg.
CDC 'Split Type':

Write-up:GARDASIL vaccine giving 12/5/07 and second injection 3/5/08. Chronic stomach pain noted for several months. Dr seen 10/24/08 for stomach pain. 3rd GARDASIL shot giving 11/12/08. Chronic stomach pain continues medical involvement continues for stomach pain. Patient seen 5/09 for severe back pain. Stomach pain continues until April 6, 2010 when patient stricken with seizures, hospitalization, blindness.


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