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This is VAERS ID 526286

History of Changes from the VAERS Wayback Machine

First Appeared on 4/14/2014

526286
VAERS Form:
Age:15.0
Gender:Female
Location:Ohio
Vaccinated:2011-01-18
Onset:2013-06-01
Submitted:2014-03-20
Entered:2014-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0096Z / 1 LA / UN

Administered by: Other      Purchased by: Other
Symptoms: Wheelchair user, Lupus-like syndrome

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1403USA008798

Write-up:This spontaneous report as received from a physician via a field employee refers to a female teenager of unknown age. In June 2013 (9 months ago) the patient was vaccinated with a dose of GARDASIL (lot #, expiration date and dose unspecified). The representative did not know which dose in the GARDASIL series the patient received "9 months ago". In June 2013 (9 months ago) the patient developed lupus-like symptoms and the patient was "basically wheel-chair bound". The field employee did not know any other details of the patient''s condition beyond the fact that the patient had not received a confirmed diagnosis. The patient had sought medical attention. The event outcome was reported as not recovered/not resolved. The reporter considered the event to be disability. Additional information has been requested.


Changed on 6/14/2014

526286 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Ohio
Vaccinated:2011-01-18
Onset:2013-06-01
Submitted:2014-03-20
Entered:2014-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0096Z / 1 LA / UN

Administered by: Other      Purchased by: Other
Symptoms: Wheelchair user, Lupus-like syndrome

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1403USA008798

Write-up:This spontaneous report as received from a physician via a field employee refers to a female teenager of unknown age. In June 2013 (9 months ago) the patient was vaccinated with a dose of GARDASIL (lot #, expiration date and dose unspecified). The representative did not know which dose in the GARDASIL series the patient received "9 months ago". In June 2013 (9 months ago) the patient developed lupus-like symptoms and the patient was "basically wheel-chair bound". The field employee did not know any other details of the patient''s condition beyond the fact that the patient had not received a confirmed diagnosis. The patient had sought medical attention. The event outcome was reported as not recovered/not resolved. The reporter considered the event to be disability. Additional information has been requested.


Changed on 3/14/2015

526286 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Ohio
Vaccinated:2011-01-18
Onset:2013-06-01
Submitted:2014-03-20
Entered:2014-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0096Z / 1 LA / UN

Administered by: Other      Purchased by: Other
Symptoms: Wheelchair user, Lupus-like syndrome

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1403USA008798

Write-up:This spontaneous report as received from a physician via a field employee refers to a female teenager of unknown age. In June 2013 (9 months ago) the patient was vaccinated with a dose of GARDASIL (lot #, expiration date and dose unspecified). The representative did not know which dose in the GARDASIL series the patient received "9 months ago". In June 2013 (9 months ago) the patient developed lupus-like symptoms and the patient was "basically wheel-chair bound". The field employee did not know any other details of the patient''s condition beyond the fact that the patient had not received a confirmed diagnosis. The patient had sought medical attention. The event outcome was reported as not recovered/not resolved. The reporter considered the event to be disability. Additional information has been requested.


Changed on 9/14/2017

526286 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:Ohio
Vaccinated:2011-01-18
Onset:2013-06-01
Submitted:2014-03-20
Entered:2014-03-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0096Z / 1 2 LA / UN

Administered by: Other      Purchased by: Other
Symptoms: Wheelchair user, Lupus-like syndrome

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1403USA008798

Write-up:This spontaneous report as received from a physician via a field employee refers to a female teenager of unknown age. In June 2013 (9 months ago) the patient was vaccinated with a dose of GARDASIL (lot #, expiration date and dose unspecified). The representative did not know which dose in the GARDASIL series the patient received "9 months ago". In June 2013 (9 months ago) the patient developed lupus-like symptoms and the patient was "basically wheel-chair bound". The field employee did not know any other details of the patient''s condition beyond the fact that the patient had not received a confirmed diagnosis. The patient had sought medical attention. The event outcome was reported as not recovered/not resolved. The reporter considered the event to be disability. Additional information has been requested.


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