National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 527628

History of Changes from the VAERS Wayback Machine

First Appeared on 4/14/2014

VAERS ID: 527628
VAERS Form:
Age:13.0
Gender:Male
Location:Pennsylvania
Vaccinated:2011-10-03
Onset:2011-10-04
Submitted:2014-04-04
Entered:2014-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 AR / SYR
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1261AA / 1 AR / SYR

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Fatigue, Headache, Myalgia

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications:
Current Illness: Just recovered from Pnuemonia and was exposed to 2nd virus that gave him a headache and body aches 2 days before shot
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Severe head pain, sore muscles, weak and tired.


Changed on 7/14/2014

VAERS ID: 527628 Before After
VAERS Form:
Age:13.0
Gender:Male
Location:Pennsylvania
Vaccinated:2011-10-03
Onset:2011-10-04
Submitted:2014-04-04
Entered:2014-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) INFLUENZA (SEASONAL) (FLUZONE) / UNKNOWN MANUFACTURER SANOFI PASTEUR - UH455AD / 1 0 AR UN / SYR UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1261AA / 1 0 AR UN / SYR UN

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Fatigue, Headache, Myalgia

Life Threatening? No
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? No Yes, days: (blank) 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Just recovered from Pnuemonia and was exposed to 2nd virus that gave him a headache and body aches 2 days before shot
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Severe head pain, sore muscles, weak and tired.


Changed on 9/14/2017

VAERS ID: 527628 Before After
VAERS Form:(blank) 1
Age:13.0
Gender:Male
Location:Pennsylvania
Vaccinated:2011-10-03
Onset:2011-10-04
Submitted:2014-04-04
Entered:2014-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH455AD / 0 1 UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1261AA / 0 1 UN / UN

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Fatigue, Headache, Myalgia

Life Threatening? No
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: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Just recovered from Pnuemonia and was exposed to 2nd virus that gave him a headache and body aches 2 days before shot
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Severe head pain, sore muscles, weak and tired.


Changed on 2/14/2018

VAERS ID: 527628 Before After
VAERS Form:1
Age:13.0
Gender:Male
Location:Pennsylvania
Vaccinated:2011-10-03
Onset:2011-10-04
Submitted:2014-04-04
Entered:2014-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH455AD / 1 UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1261AA / 1 UN / UN

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Fatigue, Headache, Myalgia

Life Threatening? No
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: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Just recovered from Pnuemonia and was exposed to 2nd virus that gave him a headache and body aches 2 days before shot
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Severe head pain, sore muscles, weak and tired.


New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=527628&WAYBACKHISTORY=ON


Copyright © 2018 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166