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This is VAERS ID 629804

History of Changes from the VAERS Wayback Machine

First Appeared on 4/14/2016

629804
VAERS Form:
Age:15.0
Gender:Female
Location:Wisconsin
Vaccinated:2013-07-22
Onset:2013-07-24
Submitted:2016-03-29
Entered:2016-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J003727 / 0 LA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Amenorrhoea, Autonomic nervous system imbalance, Dizziness, Fatigue, Headache, Hypoaesthesia, Menstrual disorder, Muscle spasms, Mydriasis, Pain, Pallor, Paraesthesia, Contusion, Tilt table test, Postural orthostatic tachycardia syndrome, Anti-Muellerian hormone level

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: giant urticaria, petechiae, epistaxis, achiness, malaise, fatigue~Varicella (Varivax)~2~10.83~Patient|fatigue, achiness, develop
Other Medications: fexofenedene for seasonal allergies and reactions to insect stings/bites Sibling received the IPV and DTaP in separate injections. He also experienced previous and subsequent vaccine reactions but my session is about to time out.
Current Illness: No known illness at the time of the vaccination.
Preexisting Conditions: Seasonal allergies, possible hyper mobility, previous immediate vaccine reaction to varicella booster(giant urticaria followed by petechiae, nose bleeds, fatigue and achiness lasting for months)
Allergies:
Diagnostic Lab Data: AMH levels and tilt table testing and full assessment available upon request.
CDC 'Split Type':

Write-up:Increased bruising noted. 8/2013 greatly decreased menstrual bleeding noted after 3 years of regular periods. Also noticed episodic dizziness and feeling faint, fatigue, generalized achiness, dilated pupils, HAs. 9/2013 Severe muscle spasm and episodic dizziness, HAs, dilated pupils continue. Menstrual period very very light, again. 10/23/2013 HPV #2 given. 11/2013 amenorrhea. Began to notice periods of facial and extremity duskiness and pallor along with above symptoms. Numbness and tingling also noted. 12/2013 AMH (antimullerian hormone which indicates ovarian reserve) is found to be similar to perimenopausal woman. Amenorrhea continues along with other symptoms. 6 through 8/2014 diagnosed with POTS/Dysautonomia.


Changed on 9/14/2017

629804 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:Wisconsin
Vaccinated:2013-07-22
Onset:2013-07-24
Submitted:2016-03-29
Entered:2016-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J003727 / 0 1 LA / IM

Administered by: Unknown      Purchased by: Private
Symptoms: Amenorrhoea, Autonomic nervous system imbalance, Dizziness, Fatigue, Headache, Hypoaesthesia, Menstrual disorder, Muscle spasms, Mydriasis, Pain, Pallor, Paraesthesia, Contusion, Tilt table test, Postural orthostatic tachycardia syndrome, Anti-Muellerian hormone level

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: giant urticaria, petechiae, epistaxis, achiness, malaise, fatigue~Varicella (Varivax)~2~10.83~Patient|fatigue, achiness, develop
Other Medications: fexofenedene for seasonal allergies and reactions to insect stings/bites Sibling received the IPV and DTaP in separate injections. He also experienced previous and subsequent vaccine reactions but my session is about to time out.
Current Illness: No known illness at the time of the vaccination.
Preexisting Conditions: Seasonal allergies, possible hyper mobility, previous immediate vaccine reaction to varicella booster(giant urticaria followed by petechiae, nose bleeds, fatigue and achiness lasting for months)
Allergies:
Diagnostic Lab Data: AMH levels and tilt table testing and full assessment available upon request.
CDC 'Split Type':

Write-up:Increased bruising noted. 8/2013 greatly decreased menstrual bleeding noted after 3 years of regular periods. Also noticed episodic dizziness and feeling faint, fatigue, generalized achiness, dilated pupils, HAs. 9/2013 Severe muscle spasm and episodic dizziness, HAs, dilated pupils continue. Menstrual period very very light, again. 10/23/2013 HPV #2 given. 11/2013 amenorrhea. Began to notice periods of facial and extremity duskiness and pallor along with above symptoms. Numbness and tingling also noted. 12/2013 AMH (antimullerian hormone which indicates ovarian reserve) is found to be similar to perimenopausal woman. Amenorrhea continues along with other symptoms. 6 through 8/2014 diagnosed with POTS/Dysautonomia.


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