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This is VAERS ID 503967

History of Changes from the VAERS Wayback Machine

First Appeared on 1/13/2014

VAERS ID: 503967
Age:12.0
Gender:Female
Location:Foreign
Vaccinated:2010-10-27
Onset:2010-11-01
Submitted:2013-09-25
Entered:2013-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. NK10770 / 1 UN / SYR

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Bone pain, Groin pain, Pain in extremity, Activities of daily living impaired, Laboratory test normal, Spinal pain

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Immunisation
Preexisting Conditions: GARDASIL, Immunisation, The patient''s medical history includes a vaccination with GARDASIL (dose 1, batch number NL30750, intramuscular route, site not reported) on 25-Aug-2010.
Diagnostic Lab Data: Unspecified laboratory tests have been performed on the patient on non-specified dates in 2013 with normal results.
CDC 'Split Type': WAES1309DNK010706

Write-up:Case received from health care professional via the Health Authorities on 16-Sep-2013 under the reference number 22241897 and EFO6856. Case medically confirmed. A 12 year old female patient (weight 55 kg and height 166 cm) had received an injection of GARDASIL (dose 2, batch number NL48770, lot number NK10770, exp 31-JAN-2012, intramuscular route, site not reported) on 27-Oct-2010 and concomitant with PRIORIX (other mfr, dose in series and batch number not reported, site and route not reported) on 25-Aug-2010 and later on 01-Nov-2010 she developed pain in groins, pain in the entire spine, pain in feet, pain in knees and pain in tibias. She had stopped taken part in sports activities as a result. The patient has also received GARDASIL vaccination (dose 3, batch number NL53870, intramuscular route, site not reported) on 02-Mar-2011. Unspecified laboratory tests have been performed on the patient on non-specified dates in 2013 with normal results. The patient has no other medications. The patient''s medical history includes a vaccination with GARDASIL (dose 1, batch number NL30750, intramuscular route, site not reported) on 25-Aug-2010. At the time of reporting, the outcome was not recovered.


Changed on 6/14/2014

VAERS ID: 503967 Before After
Age:12.0
Gender:Female
Location:Foreign
Vaccinated:2010-10-27
Onset:2010-11-01
Submitted:2013-09-25
Entered:2013-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. NK10770 / 1 UN / SYR

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Bone pain, Groin pain, Pain in extremity, Activities of daily living impaired, Laboratory test normal, Spinal pain

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Immunisation
Preexisting Conditions: GARDASIL, Immunisation, The patient''s medical history includes a vaccination with GARDASIL (dose 1, batch number NL30750, intramuscular route, site not reported) on 25-Aug-2010.
Diagnostic Lab Data: Unspecified laboratory tests have been performed on the patient on non-specified dates in 2013 with normal results.
CDC 'Split Type': WAES1309DNK010706

Write-up:Case received from health care professional via the Health Authorities on 16-Sep-2013 under the reference number 22241897 and EFO6856. Case medically confirmed. A 12 year old female patient (weight 55 kg and height 166 cm) had received an injection of GARDASIL (dose 2, batch number NL48770, lot number NK10770, exp 31-JAN-2012, intramuscular route, site not reported) on 27-Oct-2010 and concomitant with PRIORIX (other mfr, dose in series and batch number not reported, site and route not reported) on 25-Aug-2010 and later on 01-Nov-2010 she developed pain in groins, pain in the entire spine, pain in feet, pain in knees and pain in tibias. She had stopped taken part in sports activities as a result. The patient has also received GARDASIL vaccination (dose 3, batch number NL53870, intramuscular route, site not reported) on 02-Mar-2011. Unspecified laboratory tests have been performed on the patient on non-specified dates in 2013 with normal results. The patient has no other medications. The patient''s medical history includes a vaccination with GARDASIL (dose 1, batch number NL30750, intramuscular route, site not reported) on 25-Aug-2010. At the time of reporting, the outcome was not recovered.


Changed on 3/14/2015

VAERS ID: 503967 Before After
Age:12.0
Gender:Female
Location:Foreign
Vaccinated:2010-10-27
Onset:2010-11-01
Submitted:2013-09-25
Entered:2013-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. NK10770 / 1 UN / SYR

Administered by: Other      Purchased by: Other
Symptoms: Arthralgia, Bone pain, Groin pain, Pain in extremity, Activities of daily living impaired, Laboratory test normal, Spinal pain

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Immunisation
Preexisting Conditions: GARDASIL, Immunisation, The patient''s medical history includes a vaccination with GARDASIL (dose 1, batch number NL30750, intramuscular route, site not reported) on 25-Aug-2010.
Diagnostic Lab Data: Unspecified laboratory tests have been performed on the patient on non-specified dates in 2013 with normal results.
CDC 'Split Type': WAES1309DNK010706

Write-up:Case received from health care professional via the Health Authorities on 16-Sep-2013 under the reference number 22241897 and EFO6856. Case medically confirmed. A 12 year old female patient (weight 55 kg and height 166 cm) had received an injection of GARDASIL (dose 2, batch number NL48770, lot number NK10770, exp 31-JAN-2012, intramuscular route, site not reported) on 27-Oct-2010 and concomitant with PRIORIX (other mfr, dose in series and batch number not reported, site and route not reported) on 25-Aug-2010 and later on 01-Nov-2010 she developed pain in groins, pain in the entire spine, pain in feet, pain in knees and pain in tibias. She had stopped taken part in sports activities as a result. The patient has also received GARDASIL vaccination (dose 3, batch number NL53870, intramuscular route, site not reported) on 02-Mar-2011. Unspecified laboratory tests have been performed on the patient on non-specified dates in 2013 with normal results. The patient has no other medications. The patient''s medical history includes a vaccination with GARDASIL (dose 1, batch number NL30750, intramuscular route, site not reported) on 25-Aug-2010. At the time of reporting, the outcome was not recovered.


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