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This is VAERS ID 541913

History of Changes from the VAERS Wayback Machine

First Appeared on 9/14/2014

541913
VAERS Form:
Age:15.0
Gender:Female
Location:Ohio
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2014-09-01
Entered:2014-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / SYR

Administered by: Other      Purchased by: Other
Symptoms: Musculoskeletal pain, Nuclear magnetic resonance imaging

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1408USA016371

Write-up:This spontaneous report was received from a physician via company representative refers to a 15 year old female patient. There was not pertinent medical history. On an unknown date the patient was vaccinated with the second dose of GARDASIL injection, 1 single shot, (lot number, expiration date, route and dosage were not reported). Concomitant therapy was not reported. The physician informed that on an unknown date within a month of receiving the second dose of GARDASIL the patient began experiencing severe shoulder pain. No adverse effects were reported with the first dose. The patient needed physical therapy as treatment for the adverse event, a magnetic resonance imaging (MRI) was performed as diagnostic study. The patient sought an unspecified medical attention for the adverse event. The reporter determined that the shoulder pain was significant disability or incapacity. Additional information has been requested.


Changed on 9/14/2017

541913 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:Ohio
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2014-09-01
Entered:2014-09-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 2 UN / SYR

Administered by: Other      Purchased by: Other
Symptoms: Musculoskeletal pain, Nuclear magnetic resonance imaging

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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1408USA016371

Write-up:This spontaneous report was received from a physician via company representative refers to a 15 year old female patient. There was not pertinent medical history. On an unknown date the patient was vaccinated with the second dose of GARDASIL injection, 1 single shot, (lot number, expiration date, route and dosage were not reported). Concomitant therapy was not reported. The physician informed that on an unknown date within a month of receiving the second dose of GARDASIL the patient began experiencing severe shoulder pain. No adverse effects were reported with the first dose. The patient needed physical therapy as treatment for the adverse event, a magnetic resonance imaging (MRI) was performed as diagnostic study. The patient sought an unspecified medical attention for the adverse event. The reporter determined that the shoulder pain was significant disability or incapacity. Additional information has been requested.


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