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This is VAERS ID 493088

History of Changes from the VAERS Wayback Machine

First Appeared on 6/12/2013

VAERS ID: 493088
VAERS Form:
Age:15.0
Sex:Female
Location:Texas
Vaccinated:2013-03-29
Onset:2013-04-01
Submitted:2013-06-03
Entered:2013-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H015555 / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Death, Gallbladder disorder, Nausea

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1305USA017386

Write-up: Information has been received from a Licensed practical nurse, via a company representative, concerning a 15 year old female patient. On 29-MAR-2013, the patient was vaccinated with the first dose of GARDASIL (dose, route and frequency were not reported) (lot # AE0131; Expiration date was not reported). On 13-SEP-2012, the patient received the second dose of GARDASIL (dose, route and frequency were not reported) (lot # AE0131; Expiration date was not reported), and on 29-MAR-2013, the patient received the third dose of GARDASIL (dose, route and frequency were not reported) (lot #: H015555; Expiration date was not reported). It was reported that in April 2013, shortly after receiving the third dose of GARDASIL, the patient experienced significantly abdominal pain and nausea. The patient sought medical attention through doctor''s appointment, and it was determined that the patient would need to have her gallbladder removed. It was reported that surgery was planned at an unspecified time. Also it was reported that the patient discontinued GARDASIL therapy on 29-MAR-2013. It was also reported that the events did not cause significant disability or incapacity. In April 2013, the patient died. It was unknown if autopsy was performed. Cause of death was unknown. At the time of the report, the patient''s outcome for abdominal pain, gallbladder disorder and nausea was unknown. Additional information has been requested.


Changed on 9/17/2013

VAERS ID: 493088 Before After
VAERS Form:
Age:15.0
Sex:Female
Location:Texas
Vaccinated:2013-03-29
Onset:2013-04-01
Submitted:2013-06-03
Entered:2013-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H015555 / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Bilirubin conjugated increased, Blood bilirubin increased, Blood bilirubin unconjugated increased, Death, Faeces hard, Gallbladder disorder, Nausea, Hepatobiliary scan abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: No other medications
Current Illness: Unknown
Preexisting Conditions: The following information was obtained through follow-up and/or provided by the government. 6/4/13 PMH: Newborn - jaundice. Abdominal pain.
Allergies:
Diagnostic Lab Data: The following information was obtained through follow-up and/or provided by the government. 6/4/13 Labs and Diagnostics: Nuclear Medicine Hepatobiliary scan - Abnormal. moderately depressed gallbladder ejection fraction. Hepatic Function Panel - Abnormal - Bilirubin Total 1.9 mg/dl (H), Bilirubin Direct 0.4 mg/dl (H), Bilirubin Indirect 1.5 mg/dl (H). CHEM - Carbon Dioxide 18 mmol/l (H).
CDC 'Split Type': WAES1305USA017386

Write-up: Information has been received from a Licensed practical nurse, via a company representative, concerning a 15 year old female patient. On 29-MAR-2013, the patient was vaccinated with the first dose of GARDASIL (dose, route and frequency were not reported) (lot # AE0131; Expiration date was not reported). On 13-SEP-2012, the patient received the second dose of GARDASIL (dose, route and frequency were not reported) (lot # AE0131; Expiration date was not reported), and on 29-MAR-2013, the patient received the third dose of GARDASIL (dose, route and frequency were not reported) (lot #: H015555; Expiration date was not reported). It was reported that in April 2013, shortly after receiving the third dose of GARDASIL, the patient experienced significantly abdominal pain and nausea. The patient sought medical attention through doctor''s appointment, and it was determined that the patient would need to have her gallbladder removed. It was reported that surgery was planned at an unspecified time. Also it was reported that the patient discontinued GARDASIL therapy on 29-MAR-2013. It was also reported that the events did not cause significant disability or incapacity. In April 2013, the patient died. It was unknown if autopsy was performed. Cause of death was unknown. At the time of the report, the patient''s outcome for abdominal pain, gallbladder disorder and nausea was unknown. Additional information has been requested. The following information was obtained through follow-up and/or provided by the government. 6/4/13 PCP Medical records received. Service date 5/1/13. Diagnosis: Abdominal Pain. Patient presents with intermittent abdominal pain (2 weeks). Diffuse, occurs after meals. Hard stools. In no distress, normal exam.


Changed on 3/14/2015

VAERS ID: 493088 Before After
VAERS Form:
Age:15.0
Sex:Female
Location:Texas
Vaccinated:2013-03-29
Onset:2013-04-01
Submitted:2013-06-03
Entered:2013-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H015555 / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Bilirubin conjugated increased, Blood bilirubin increased, Blood bilirubin unconjugated increased, Death, Faeces hard, Gallbladder disorder, Nausea, Hepatobiliary scan abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: No other medications
Current Illness: Unknown
Preexisting Conditions: The following information was obtained through follow-up and/or provided by the government. 6/4/13 PMH: Newborn - jaundice. Abdominal pain.
Allergies:
Diagnostic Lab Data: The following information was obtained through follow-up and/or provided by the government. 6/4/13 Labs and Diagnostics: Nuclear Medicine Hepatobiliary scan - Abnormal. moderately depressed gallbladder ejection fraction. Hepatic Function Panel - Abnormal - Bilirubin Total 1.9 mg/dl (H), Bilirubin Direct 0.4 mg/dl (H), Bilirubin Indirect 1.5 mg/dl (H). CHEM - Carbon Dioxide 18 mmol/l (H).
CDC 'Split Type': WAES1305USA017386

Write-up: Information has been received from a Licensed practical nurse, via a company representative, concerning a 15 year old female patient. On 29-MAR-2013, the patient was vaccinated with the first dose of GARDASIL (dose, route and frequency were not reported) (lot # AE0131; Expiration date was not reported). On 13-SEP-2012, the patient received the second dose of GARDASIL (dose, route and frequency were not reported) (lot # AE0131; Expiration date was not reported), and on 29-MAR-2013, the patient received the third dose of GARDASIL (dose, route and frequency were not reported) (lot #: H015555; Expiration date was not reported). It was reported that in April 2013, shortly after receiving the third dose of GARDASIL, the patient experienced significantly abdominal pain and nausea. The patient sought medical attention through doctor''s appointment, and it was determined that the patient would need to have her gallbladder removed. It was reported that surgery was planned at an unspecified time. Also it was reported that the patient discontinued GARDASIL therapy on 29-MAR-2013. It was also reported that the events did not cause significant disability or incapacity. In April 2013, the patient died. It was unknown if autopsy was performed. Cause of death was unknown. At the time of the report, the patient''s outcome for abdominal pain, gallbladder disorder and nausea was unknown. Additional information has been requested. The following information was obtained through follow-up and/or provided by the government. 6/4/13 PCP Medical records received. Service date 5/1/13. Diagnosis: Abdominal Pain. Patient presents with intermittent abdominal pain (2 weeks). Diffuse, occurs after meals. Hard stools. In no distress, normal exam.


Changed on 9/14/2017

VAERS ID: 493088 Before After
VAERS Form:(blank) 1
Age:15.0
Sex:Female
Location:Texas
Vaccinated:2013-03-29
Onset:2013-04-01
Submitted:2013-06-03
Entered:2013-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H015555 / 2 3 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Death, Gallbladder disorder, Nausea

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1305USA017386

Write-up: Information has been received from a Licensed practical nurse, via a company representative, concerning a 15 year old female patient. On 29-MAR-2013, the patient was vaccinated with the first dose of GARDASIL (dose, route and frequency were not reported) (lot # AE0131; Expiration date was not reported). On 13-SEP-2012, the patient received the second dose of GARDASIL (dose, route and frequency were not reported) (lot # AE0131; Expiration date was not reported), and on 29-MAR-2013, the patient received the third dose of GARDASIL (dose, route and frequency were not reported) (lot #: H015555; Expiration date was not reported). It was reported that in April 2013, shortly after receiving the third dose of GARDASIL, the patient experienced significantly abdominal pain and nausea. The patient sought medical attention through doctor''s appointment, and it was determined that the patient would need to have her gallbladder removed. It was reported that surgery was planned at an unspecified time. Also it was reported that the patient discontinued GARDASIL therapy on 29-MAR-2013. It was also reported that the events did not cause significant disability or incapacity. In April 2013, the patient died. It was unknown if autopsy was performed. Cause of death was unknown. At the time of the report, the patient''s outcome for abdominal pain, gallbladder disorder and nausea was unknown. Additional information has been requested.


Changed on 2/14/2018

VAERS ID: 493088 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Texas
Vaccinated:2013-03-29
Onset:2013-04-01
Submitted:2013-06-03
Entered:2013-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H015555 / 3 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Death, Gallbladder disorder, Nausea

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1305USA017386

Write-up: Information has been received from a Licensed practical nurse, via a company representative, concerning a 15 year old female patient. On 29-MAR-2013, the patient was vaccinated with the first dose of GARDASIL (dose, route and frequency were not reported) (lot # AE0131; Expiration date was not reported). On 13-SEP-2012, the patient received the second dose of GARDASIL (dose, route and frequency were not reported) (lot # AE0131; Expiration date was not reported), and on 29-MAR-2013, the patient received the third dose of GARDASIL (dose, route and frequency were not reported) (lot #: H015555; Expiration date was not reported). It was reported that in April 2013, shortly after receiving the third dose of GARDASIL, the patient experienced significantly abdominal pain and nausea. The patient sought medical attention through doctor''s appointment, and it was determined that the patient would need to have her gallbladder removed. It was reported that surgery was planned at an unspecified time. Also it was reported that the patient discontinued GARDASIL therapy on 29-MAR-2013. It was also reported that the events did not cause significant disability or incapacity. In April 2013, the patient died. It was unknown if autopsy was performed. Cause of death was unknown. At the time of the report, the patient''s outcome for abdominal pain, gallbladder disorder and nausea was unknown. Additional information has been requested.


Changed on 6/14/2018

VAERS ID: 493088 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Texas
Vaccinated:2013-03-29
Onset:2013-04-01
Submitted:2013-06-03
Entered:2013-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H015555 / 3 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Death, Gallbladder disorder, Nausea

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1305USA017386

Write-up: Information has been received from a Licensed practical nurse, via a company representative, concerning a 15 year old female patient. On 29-MAR-2013, the patient was vaccinated with the first dose of GARDASIL (dose, route and frequency were not reported) (lot # AE0131; Expiration date was not reported). On 13-SEP-2012, the patient received the second dose of GARDASIL (dose, route and frequency were not reported) (lot # AE0131; Expiration date was not reported), and on 29-MAR-2013, the patient received the third dose of GARDASIL (dose, route and frequency were not reported) (lot #: H015555; Expiration date was not reported). It was reported that in April 2013, shortly after receiving the third dose of GARDASIL, the patient experienced significantly abdominal pain and nausea. The patient sought medical attention through doctor''s appointment, and it was determined that the patient would need to have her gallbladder removed. It was reported that surgery was planned at an unspecified time. Also it was reported that the patient discontinued GARDASIL therapy on 29-MAR-2013. It was also reported that the events did not cause significant disability or incapacity. In April 2013, the patient died. It was unknown if autopsy was performed. Cause of death was unknown. At the time of the report, the patient''s outcome for abdominal pain, gallbladder disorder and nausea was unknown. Additional information has been requested.


Changed on 8/14/2018

VAERS ID: 493088 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Texas
Vaccinated:2013-03-29
Onset:2013-04-01
Submitted:2013-06-03
Entered:2013-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H015555 / 3 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Death, Gallbladder disorder, Nausea

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1305USA017386

Write-up: Information has been received from a Licensed practical nurse, via a company representative, concerning a 15 year old female patient. On 29-MAR-2013, the patient was vaccinated with the first dose of GARDASIL (dose, route and frequency were not reported) (lot # AE0131; Expiration date was not reported). On 13-SEP-2012, the patient received the second dose of GARDASIL (dose, route and frequency were not reported) (lot # AE0131; Expiration date was not reported), and on 29-MAR-2013, the patient received the third dose of GARDASIL (dose, route and frequency were not reported) (lot #: H015555; Expiration date was not reported). It was reported that in April 2013, shortly after receiving the third dose of GARDASIL, the patient experienced significantly abdominal pain and nausea. The patient sought medical attention through doctor''s appointment, and it was determined that the patient would need to have her gallbladder removed. It was reported that surgery was planned at an unspecified time. Also it was reported that the patient discontinued GARDASIL therapy on 29-MAR-2013. It was also reported that the events did not cause significant disability or incapacity. In April 2013, the patient died. It was unknown if autopsy was performed. Cause of death was unknown. At the time of the report, the patient''s outcome for abdominal pain, gallbladder disorder and nausea was unknown. Additional information has been requested.


Changed on 9/14/2018

VAERS ID: 493088 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Texas
Vaccinated:2013-03-29
Onset:2013-04-01
Submitted:2013-06-03
Entered:2013-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H015555 / 3 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Death, Gallbladder disorder, Nausea

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1305USA017386

Write-up: Information has been received from a Licensed practical nurse, via a company representative, concerning a 15 year old female patient. On 29-MAR-2013, the patient was vaccinated with the first dose of GARDASIL (dose, route and frequency were not reported) (lot # AE0131; Expiration date was not reported). On 13-SEP-2012, the patient received the second dose of GARDASIL (dose, route and frequency were not reported) (lot # AE0131; Expiration date was not reported), and on 29-MAR-2013, the patient received the third dose of GARDASIL (dose, route and frequency were not reported) (lot #: H015555; Expiration date was not reported). It was reported that in April 2013, shortly after receiving the third dose of GARDASIL, the patient experienced significantly abdominal pain and nausea. The patient sought medical attention through doctor''s appointment, and it was determined that the patient would need to have her gallbladder removed. It was reported that surgery was planned at an unspecified time. Also it was reported that the patient discontinued GARDASIL therapy on 29-MAR-2013. It was also reported that the events did not cause significant disability or incapacity. In April 2013, the patient died. It was unknown if autopsy was performed. Cause of death was unknown. At the time of the report, the patient''s outcome for abdominal pain, gallbladder disorder and nausea was unknown. Additional information has been requested.


Changed on 10/14/2018

VAERS ID: 493088 Before After
VAERS Form:1
Age:15.0
Sex:Female
Location:Texas
Vaccinated:2013-03-29
Onset:2013-04-01
Submitted:2013-06-03
Entered:2013-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H015555 / 3 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Death, Gallbladder disorder, Nausea

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1305USA017386

Write-up: Information has been received from a Licensed practical nurse, via a company representative, concerning a 15 year old female patient. On 29-MAR-2013, the patient was vaccinated with the first dose of GARDASIL (dose, route and frequency were not reported) (lot # AE0131; Expiration date was not reported). On 13-SEP-2012, the patient received the second dose of GARDASIL (dose, route and frequency were not reported) (lot # AE0131; Expiration date was not reported), and on 29-MAR-2013, the patient received the third dose of GARDASIL (dose, route and frequency were not reported) (lot #: H015555; Expiration date was not reported). It was reported that in April 2013, shortly after receiving the third dose of GARDASIL, the patient experienced significantly abdominal pain and nausea. The patient sought medical attention through doctor''s appointment, and it was determined that the patient would need to have her gallbladder removed. It was reported that surgery was planned at an unspecified time. Also it was reported that the patient discontinued GARDASIL therapy on 29-MAR-2013. It was also reported that the events did not cause significant disability or incapacity. In April 2013, the patient died. It was unknown if autopsy was performed. Cause of death was unknown. At the time of the report, the patient''s outcome for abdominal pain, gallbladder disorder and nausea was unknown. Additional information has been requested.

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