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This is VAERS ID 487741

History of Changes from the VAERS Wayback Machine

First Appeared on 4/13/2013

487741
VAERS Form:
Age:13.0
Gender:Female
Location:Ohio
Vaccinated:2009-03-04
Onset:2009-07-27
Submitted:2013-03-25
Entered:2013-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 1297X / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0072Z / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2568AA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR UF457CA / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Asthenia, Blood glucose increased, Pancreatic disorder, Pollakiuria, Thirst, Vomiting, Type 1 diabetes mellitus

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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Patient was showing signs of weakness, vomiting, extremely thirsty, using bathroom a lot, after taking her to doctor her blood sugar was well over 600 therfore causing her to be sent straight to hospital where she wad diagnosed with pancreatic failure and is now insulin dependant.


Changed on 6/12/2013

487741 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Ohio
Vaccinated:2009-03-04
Onset:2009-07-27
Submitted:2013-03-25
Entered:2013-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 1297X / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0072Z / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2568AA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR UF457CA / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Asthenia, Blood glucose increased, Pancreatic disorder, Pollakiuria, Thirst, Vomiting, Type 1 diabetes mellitus

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: 4 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Patient was showing signs of weakness, vomiting, extremely thirsty, using bathroom a lot, after taking her to doctor her blood sugar was well over 600 therfore causing her to be sent straight to hospital where she wad diagnosed with pancreatic failure and is now insulin dependant.


Changed on 9/17/2013

487741 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Ohio
Vaccinated:2009-03-04
Onset:2009-07-27
Submitted:2013-03-25
Entered:2013-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 1297X / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0072Z / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2568AA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR UF457CA / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Asthenia, Blood gases abnormal, Blood glucose increased, Blood urea increased, Dizziness, Dry mouth, Fatigue, Glucose urine present, Glycosylated haemoglobin increased, Haematocrit increased, Haemoglobin increased, Mucosal dryness, Nausea, Pancreatic disorder, Pollakiuria, Polydipsia, Polyuria, Red blood cell count normal, Red blood cells urine positive, Thirst, Thyroid function test normal, Urine abnormality, Vomiting, Weight decreased, White blood cells urine positive, Specific gravity urine increased, Urine leukocyte esterase positive, Temperature intolerance, Urine ketone body present, Type 1 diabetes mellitus

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The following information was obtained through follow-up and/or provided by the government. Family hx DM Type II.
Allergies:
Diagnostic Lab Data: The following information was obtained through follow-up and/or provided by the government. 5/7/2013 lab/diagnostic records received for DOS 7/20-22/2009. Blood: RBC 5.41 M/mcL (N), Hct 51% (H), Hgb 17.3 g/dL (H), glucose 495 mg/dL (H), Hgb A1c 13% (H), BUN 21 mg/dL (H). UA: hazy, spec grav 1.032 (H), ketone 40 (H), WBC 30-49 (H), RBC 50+ (H), glucose $g1000 (H), leukocyte esterase (+). Blood gases abnormal. Thyriod panel WNL.
CDC 'Split Type':

Write-up:Patient was showing signs of weakness, vomiting, extremely thirsty, using bathroom a lot, after taking her to doctor her blood sugar was well over 600 therfore causing her to be sent straight to hospital where she wad diagnosed with pancreatic failure and is now insulin dependant. The following information was obtained through follow-up and/or provided by the government. 5/7/2013 hospital records received for DOS 7/20-22/2009. D/c Dx: new onset DM type I. Pt presented w/ 2 wk hx polyuria, polydipsia, fatigue, dizziness/lightheadedness on standing, cold intolerance; 2 day hx dry mouth; 1 day hx vomiting, nausea, abdominal pain; weight loss. PCP noted elevated glucose & (+) urine ketones, sent pt to ER. PE: dry mucous membranes, abnormal labs. Admitted. Tx''t: IVF, insulin initiation, diabetes education. Pt d/c''d home in good condition w/ Rx, care & f/u instructions.


Changed on 3/14/2015

487741 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Ohio
Vaccinated:2009-03-04
Onset:2009-07-27
Submitted:2013-03-25
Entered:2013-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 1297X / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0072Z / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2568AA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR UF457CA / 0 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Abdominal pain, Asthenia, Blood gases abnormal, Blood glucose increased, Blood urea increased, Dizziness, Dry mouth, Fatigue, Glucose urine present, Glycosylated haemoglobin increased, Haematocrit increased, Haemoglobin increased, Mucosal dryness, Nausea, Pancreatic disorder, Pollakiuria, Polydipsia, Polyuria, Red blood cell count normal, Red blood cells urine positive, Thirst, Thyroid function test normal, Urine abnormality, Vomiting, Weight decreased, White blood cells urine positive, Specific gravity urine increased, Urine leukocyte esterase positive, Temperature intolerance, Urine ketone body present, Type 1 diabetes mellitus

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The following information was obtained through follow-up and/or provided by the government. Family hx DM Type II.
Allergies:
Diagnostic Lab Data: The following information was obtained through follow-up and/or provided by the government. 5/7/2013 lab/diagnostic records received for DOS 7/20-22/2009. Blood: RBC 5.41 M/mcL (N), Hct 51% (H), Hgb 17.3 g/dL (H), glucose 495 mg/dL (H), Hgb A1c 13% (H), BUN 21 mg/dL (H). UA: hazy, spec grav 1.032 (H), ketone 40 (H), WBC 30-49 (H), RBC 50+ (H), glucose $g1000 (H), leukocyte esterase (+). Blood gases abnormal. Thyriod panel WNL.
CDC 'Split Type':

Write-up:Patient was showing signs of weakness, vomiting, extremely thirsty, using bathroom a lot, after taking her to doctor her blood sugar was well over 600 therfore causing her to be sent straight to hospital where she wad diagnosed with pancreatic failure and is now insulin dependant. The following information was obtained through follow-up and/or provided by the government. 5/7/2013 hospital records received for DOS 7/20-22/2009. D/c Dx: new onset DM type I. Pt presented w/ 2 wk hx polyuria, polydipsia, fatigue, dizziness/lightheadedness on standing, cold intolerance; 2 day hx dry mouth; 1 day hx vomiting, nausea, abdominal pain; weight loss. PCP noted elevated glucose & (+) urine ketones, sent pt to ER. PE: dry mucous membranes, abnormal labs. Admitted. Tx''t: IVF, insulin initiation, diabetes education. Pt d/c''d home in good condition w/ Rx, care & f/u instructions.


Changed on 9/14/2017

487741 Before After
VAERS Form:(blank) 1
Age:13.0
Gender:Female
Location:Ohio
Vaccinated:2009-03-04
Onset:2009-07-27
Submitted:2013-03-25
Entered:2013-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 1297X / 0 1 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0072Z / 0 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2568AA / 0 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR UF457CA / 0 1 LA / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Asthenia, Blood glucose increased, Pancreatic disorder, Pollakiuria, Thirst, Vomiting, Type 1 diabetes mellitus

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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up:Patient was showing signs of weakness, vomiting, extremely thirsty, using bathroom a lot, after taking her to doctor her blood sugar was well over 600 therfore causing her to be sent straight to hospital where she wad diagnosed with pancreatic failure and is now insulin dependant.


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