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This is VAERS ID 515090

History of Changes from the VAERS Wayback Machine

First Appeared on 3/14/2014

515090
VAERS Form:
Age:13.0
Gender:Female
Location:Foreign
Vaccinated:2012-03-21
Onset:2012-03-28
Submitted:2013-11-29
Entered:2013-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Syncope, Post viral fatigue syndrome, Investigation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: BOOSTRIX
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1311IRL011956

Write-up:Information has been received from SPMSD (IE-1577272925-E2013-09803) on 26-NOV-2013. This cases was received from health authority in a foreign country on 21-Nov-2013. IMB REF 2013-018774. The case is medically confirmed. A 13 year old female patient, received a third dose of GARDASIL (batch number not reported) by intramuscular route, site of administration not reported and an injection of BOOSTRIX (batch number AC37B062AQ) by intramuscular route, dose in series and site of administration not reported, on 21-MAR-2012. On 28-MAR-2012, several days after vaccination, the patient collapsed and was subsequently diagnosed with myalgic encephalomyelitis with severe symptoms. The patient attended hospital for ongoing management and has had extensive investigations (no results reported). The patient previously received a first dose of GARDASIL (batch number not reported), by intramuscular route, site of administration not reported, on 19-SEP-2011 and a second dose of GARDASIL (batch number not reported), by intramuscular route, site of administration not reported, on an unspecified date. At the time of reporting, the patient was not recovered. The IMB considered that case serious due to the patient''s disability and to be medically significant.


Changed on 6/14/2014

515090 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Foreign
Vaccinated:2012-03-21
Onset:2012-03-28
Submitted:2013-11-29
Entered:2013-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Syncope, Post viral fatigue syndrome, Investigation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: BOOSTRIX
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1311IRL011956

Write-up:Information has been received from SPMSD (IE-1577272925-E2013-09803) on 26-NOV-2013. This cases was received from health authority in a foreign country on 21-Nov-2013. IMB REF 2013-018774. The case is medically confirmed. A 13 year old female patient, received a third dose of GARDASIL (batch number not reported) by intramuscular route, site of administration not reported and an injection of BOOSTRIX (batch number AC37B062AQ) by intramuscular route, dose in series and site of administration not reported, on 21-MAR-2012. On 28-MAR-2012, several days after vaccination, the patient collapsed and was subsequently diagnosed with myalgic encephalomyelitis with severe symptoms. The patient attended hospital for ongoing management and has had extensive investigations (no results reported). The patient previously received a first dose of GARDASIL (batch number not reported), by intramuscular route, site of administration not reported, on 19-SEP-2011 and a second dose of GARDASIL (batch number not reported), by intramuscular route, site of administration not reported, on an unspecified date. At the time of reporting, the patient was not recovered. The IMB considered that case serious due to the patient''s disability and to be medically significant.


Changed on 3/14/2015

515090 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Foreign
Vaccinated:2012-03-21
Onset:2012-03-28
Submitted:2013-11-29
Entered:2013-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Syncope, Post viral fatigue syndrome, Investigation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: BOOSTRIX
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1311IRL011956

Write-up:Information has been received from SPMSD (IE-1577272925-E2013-09803) on 26-NOV-2013. This cases was received from health authority in a foreign country on 21-Nov-2013. IMB REF 2013-018774. The case is medically confirmed. A 13 year old female patient, received a third dose of GARDASIL (batch number not reported) by intramuscular route, site of administration not reported and an injection of BOOSTRIX (batch number AC37B062AQ) by intramuscular route, dose in series and site of administration not reported, on 21-MAR-2012. On 28-MAR-2012, several days after vaccination, the patient collapsed and was subsequently diagnosed with myalgic encephalomyelitis with severe symptoms. The patient attended hospital for ongoing management and has had extensive investigations (no results reported). The patient previously received a first dose of GARDASIL (batch number not reported), by intramuscular route, site of administration not reported, on 19-SEP-2011 and a second dose of GARDASIL (batch number not reported), by intramuscular route, site of administration not reported, on an unspecified date. At the time of reporting, the patient was not recovered. The IMB considered that case serious due to the patient''s disability and to be medically significant.


Changed on 9/14/2017

515090 Before After
VAERS Form:(blank) 1
Age:13.0
Gender:Female
Location:Foreign
Vaccinated:2012-03-21
Onset:2012-03-28
Submitted:2013-11-29
Entered:2013-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 3 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Syncope, Post viral fatigue syndrome, Investigation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: BOOSTRIX
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1311IRL011956

Write-up:Information has been received from SPMSD (IE-1577272925-E2013-09803) on 26-NOV-2013. This cases was received from health authority in a foreign country on 21-Nov-2013. IMB REF 2013-018774. The case is medically confirmed. A 13 year old female patient, received a third dose of GARDASIL (batch number not reported) by intramuscular route, site of administration not reported and an injection of BOOSTRIX (batch number AC37B062AQ) by intramuscular route, dose in series and site of administration not reported, on 21-MAR-2012. On 28-MAR-2012, several days after vaccination, the patient collapsed and was subsequently diagnosed with myalgic encephalomyelitis with severe symptoms. The patient attended hospital for ongoing management and has had extensive investigations (no results reported). The patient previously received a first dose of GARDASIL (batch number not reported), by intramuscular route, site of administration not reported, on 19-SEP-2011 and a second dose of GARDASIL (batch number not reported), by intramuscular route, site of administration not reported, on an unspecified date. At the time of reporting, the patient was not recovered. The IMB considered that case serious due to the patient''s disability and to be medically significant.


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