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This is VAERS ID 620746

History of Changes from the VAERS Wayback Machine

First Appeared on 4/14/2017

620746
VAERS Form:
Age:14.0
Gender:Female
Location:Foreign
Vaccinated:0000-00-00
Onset:2012-09-12
Submitted:2016-01-19
Entered:2016-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Depression, Fatigue, Decreased appetite

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': WAES1601IRL005248

Write-up:Information has been received from Sanofi Pasteur MSD (manufacturer number# IE-1577272925-2016000210 on 15-JAN-2016. This case was received from the health authority on 13-Jan-2016. Initial report was received by the HA on 14-DEC-2015 from a Community Pharmacist concerning a 14 year old female patient who experienced decreased appetite, depression, abdominal pain and fatigue following vaccination with GARDASIL. The patient was not receiving any concomitant medications. The patient''s medical history/concurrent conditions were not reported. The patient was vaccinated with three doses of GARDASIL (lot numbers # also reported as "GO19345", "HO08259", "HO13055") intramuscularly between 12/Sep/2012 and 06/Jun/2013. On 12/Sep/2012, the patient developed anorexia, depression, abdominal pain and fatigue which the reporter considered to be persistently or significantly disabling/incapacitating. The events was also considered to be medically significant. At the time of reporting the patient outcome was reported as not recovered/not resolved. Lot numbers # G019345, H008259 and H013055 are valid on 18-JAN-2016.


Changed on 9/14/2017

620746 Before After
VAERS Form:(blank) 1
Age:14.0
Gender:Female
Location:Foreign
Vaccinated:0000-00-00
Onset:2012-09-12
Submitted:2016-01-19
Entered:2016-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 1 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Depression, Fatigue, Decreased appetite

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': WAES1601IRL005248

Write-up:Information has been received from Sanofi Pasteur MSD (manufacturer number# IE-1577272925-2016000210 on 15-JAN-2016. This case was received from the health authority on 13-Jan-2016. Initial report was received by the HA on 14-DEC-2015 from a Community Pharmacist concerning a 14 year old female patient who experienced decreased appetite, depression, abdominal pain and fatigue following vaccination with GARDASIL. The patient was not receiving any concomitant medications. The patient''s medical history/concurrent conditions were not reported. The patient was vaccinated with three doses of GARDASIL (lot numbers # also reported as "GO19345", "HO08259", "HO13055") intramuscularly between 12/Sep/2012 and 06/Jun/2013. On 12/Sep/2012, the patient developed anorexia, depression, abdominal pain and fatigue which the reporter considered to be persistently or significantly disabling/incapacitating. The events was also considered to be medically significant. At the time of reporting the patient outcome was reported as not recovered/not resolved. Lot numbers # G019345, H008259 and H013055 are valid on 18-JAN-2016.


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