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This is VAERS ID 545352

History of Changes from the VAERS Wayback Machine

First Appeared on 10/14/2014

545352
VAERS Form:
Age:11.0
Gender:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2014-09-26
Entered:2014-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / UN

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain upper, Bradycardia, Grand mal convulsion, Hypotension, Paralysis, Syncope, Activities of daily living impaired

Life Threatening? Yes
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': WAES1409USA012108

Write-up:This spontaneous report as received from a consumer also reporter as a private investigator refers to an 11 year old female patient (also reported as 15 year old female). Pertinent medical history, drug reactions or allergies were not reported. On an unknown date, at the age of 11 years old, the patient was vaccinated with GARDASIL (dose, dose number, dose schedule, route, anatomical location, lot number and expiration date were not reported). No concomitant therapies were reported. On an unknown date, 15 minutes after receiving the GARDASIL, the patient experienced grand mal seizure at the unspecified physician''s office. On unspecified dates, the patient experienced stomach pain, low blood pressure, syncope with episodes of bradycardia and paralysis. The patient also had missed school on unspecified dates for 18 months as a result of these adverse events. Laboratory diagnostic studies were not reported. The reported stated that the receiving GARDASIL, nearly cost patient''s life. The outcome of the events was reported as not recovered. The relatedness between the events and GARDASIL was not reported. Grand mal seizure, stomach pain, low blood pressure, syncope with episodes of bradycardia and paralysis were considered to be life threatening and disabling by the reporter. Upon internal review, grand mal seizure and paralysis were considered to be medically significant. Additional information is not expected because the reporter refused additional contact.


Changed on 9/14/2017

545352 Before After
VAERS Form:(blank) 1
Age:11.0
Gender:Female
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2014-09-26
Entered:2014-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UNK UN / UN

Administered by: Private      Purchased by: Other
Symptoms: Abdominal pain upper, Bradycardia, Grand mal convulsion, Hypotension, Paralysis, Syncope, Activities of daily living impaired

Life Threatening? Yes
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': WAES1409USA012108

Write-up:This spontaneous report as received from a consumer also reporter as a private investigator refers to an 11 year old female patient (also reported as 15 year old female). Pertinent medical history, drug reactions or allergies were not reported. On an unknown date, at the age of 11 years old, the patient was vaccinated with GARDASIL (dose, dose number, dose schedule, route, anatomical location, lot number and expiration date were not reported). No concomitant therapies were reported. On an unknown date, 15 minutes after receiving the GARDASIL, the patient experienced grand mal seizure at the unspecified physician''s office. On unspecified dates, the patient experienced stomach pain, low blood pressure, syncope with episodes of bradycardia and paralysis. The patient also had missed school on unspecified dates for 18 months as a result of these adverse events. Laboratory diagnostic studies were not reported. The reported stated that the receiving GARDASIL, nearly cost patient''s life. The outcome of the events was reported as not recovered. The relatedness between the events and GARDASIL was not reported. Grand mal seizure, stomach pain, low blood pressure, syncope with episodes of bradycardia and paralysis were considered to be life threatening and disabling by the reporter. Upon internal review, grand mal seizure and paralysis were considered to be medically significant. Additional information is not expected because the reporter refused additional contact.


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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=545352&WAYBACKHISTORY=ON


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