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This is VAERS ID 629697

History of Changes from the VAERS Wayback Machine

First Appeared on 3/14/2017

629697
VAERS Form:
Age:13.0
Gender:Female
Location:Foreign
Vaccinated:2012-03-21
Onset:0000-00-00
Submitted:2016-02-26
Entered:2016-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Dizziness, Fatigue, Menstrual disorder, Nausea

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Immunisation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1602IRL011235

Write-up:Information has been received from Sanofi Pasteur MSD (reference # IE-1577272925-2016001591) on 23-FEB-2016. This case was received from the health authority on 19-Feb-2016. Ref IE-HPRA-2016-025943. Initial report was received by the RA on 04/Feb/2016 from a member of the public (patient''s mother) which concerns a 13 year old female patient who experienced Dizziness, Nausea, Fatigue and Menstrual disorder following vaccination with GARDASIL (batch/lot # and expiration date not reported). Concomitant medications: None. Medical history/concurrent conditions: None reported. The patient was vaccinated with GARDASIL on 23/Sep/2011 and 21/Mar/2012. Post vaccination, the patient experienced dizziness, nausea, tiredness and menstrual problems that are ongoing to date. Corrective treatment: None reported.


Changed on 9/14/2017

629697 Before After
VAERS Form:(blank) 1
Age:13.0
Gender:Female
Location:Foreign
Vaccinated:2012-03-21
Onset:0000-00-00
Submitted:2016-02-26
Entered:2016-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Dizziness, Fatigue, Menstrual disorder, Nausea

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Immunisation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1602IRL011235

Write-up:Information has been received from Sanofi Pasteur MSD (reference # IE-1577272925-2016001591) on 23-FEB-2016. This case was received from the health authority on 19-Feb-2016. Ref IE-HPRA-2016-025943. Initial report was received by the RA on 04/Feb/2016 from a member of the public (patient''s mother) which concerns a 13 year old female patient who experienced Dizziness, Nausea, Fatigue and Menstrual disorder following vaccination with GARDASIL (batch/lot # and expiration date not reported). Concomitant medications: None. Medical history/concurrent conditions: None reported. The patient was vaccinated with GARDASIL on 23/Sep/2011 and 21/Mar/2012. Post vaccination, the patient experienced dizziness, nausea, tiredness and menstrual problems that are ongoing to date. Corrective treatment: None reported.


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