National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 674987

History of Changes from the VAERS Wayback Machine

First Appeared on 4/14/2017

674987
VAERS Form:
Age:12.0
Gender:Female
Location:Foreign
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2016-12-27
Entered:2016-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / UN

Administered by: Other      Purchased by: Unknown
Symptoms: Appendicitis perforated, Fatigue, Headache, Tachycardia, Postural orthostatic tachycardia syndrome, Complex regional pain syndrome, Weight bearing difficulty

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GB0095075131612GBR013259

Write-up:This spontaneous report was received from a consumer via the Agency (case report number GB-MHRA-EYC 00150652) referring to a 12 year old female patient. On an unspecified date in 2011, the patient was vaccinated with unknown dose number of GARDASIL, 3 DF, parenteral. On an unspecified date in 2011, the patient experienced burst appendix, complex regional pain syndrome, postural orthostatic tachycardia syndrome (POTS) symptoms, tachycardia, headache, chronic fatigue and unable to weight bear on either leg. The outcome of complex regional pain syndrome, weight bearing difficulty, tachycardia, appendicitis perforated, fatigue and headache was reported as not recovered. The relationship between adverse events and therapy was not provided. Additional information is not expected as no follow up can be obtained from the Agency.


Changed on 9/14/2017

674987 Before After
VAERS Form:(blank) 1
Age:12.0
Gender:Female
Location:Foreign
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:2016-12-27
Entered:2016-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UNK UN / UN

Administered by: Other      Purchased by: Unknown
Symptoms: Appendicitis perforated, Fatigue, Headache, Tachycardia, Postural orthostatic tachycardia syndrome, Complex regional pain syndrome, Weight bearing difficulty

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GB0095075131612GBR013259

Write-up:This spontaneous report was received from a consumer via the Agency (case report number GB-MHRA-EYC 00150652) referring to a 12 year old female patient. On an unspecified date in 2011, the patient was vaccinated with unknown dose number of GARDASIL, 3 DF, parenteral. On an unspecified date in 2011, the patient experienced burst appendix, complex regional pain syndrome, postural orthostatic tachycardia syndrome (POTS) symptoms, tachycardia, headache, chronic fatigue and unable to weight bear on either leg. The outcome of complex regional pain syndrome, weight bearing difficulty, tachycardia, appendicitis perforated, fatigue and headache was reported as not recovered. The relationship between adverse events and therapy was not provided. Additional information is not expected as no follow up can be obtained from the Agency.


New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=674987&WAYBACKHISTORY=ON


Copyright © 2017 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166