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This is VAERS ID 675329

History of Changes from the VAERS Wayback Machine

First Appeared on 2/14/2017

675329
VAERS Form:
Age:
Gender:Female
Location:Foreign
Vaccinated:2014-03-24
Onset:2014-03-24
Submitted:2016-10-31
Entered:2016-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Epstein-Barr virus infection, Bedridden, Post viral fatigue syndrome

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: Baclofen; azithromycin; lansoprazole
Current Illness: Immunodeficiency common variable, variable immune deficiency; Immunisation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1610GBR015251

Write-up:Information was received from Sanofi Pasteur (manufacturer control # 2016010903) as part of a business agreement on 28-OCT-2016. This case was received from the RA on 26-OCT-2016 under the reference number GB-MHRA-ADR 23693153. Case received from a consumer/other non health professional. A 15-year-old female adolescent patient received GARDASIL, (batch number unknown) via parenteral route on 24-MAR-2014, GARDAIL, (batch number unknown) via parenteral route on 28-JUL-2014. The patient received concomitant administration of: -Baclofen on an unknown date, -Azithromycin on an unknown date, -Lansoprazole on an unknown date. The patient was firstly bed ridden after second was told this was unusual (onset date 24-MAR-2014). She also experienced Epstein-Barre virus infection and post viral fatigue syndrome on an unknown date. The patient had a medical history of immunodeficiency common variable. The patient''s outcome was reported as Not Recovered/Not Resolved.


Changed on 9/14/2017

675329 Before After
VAERS Form:(blank) 1
Age:
Gender:Female
Location:Foreign
Vaccinated:2014-03-24
Onset:2014-03-24
Submitted:2016-10-31
Entered:2016-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Epstein-Barr virus infection, Bedridden, Post viral fatigue syndrome

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: Baclofen; azithromycin; lansoprazole
Current Illness: Immunodeficiency common variable, variable immune deficiency; Immunisation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1610GBR015251

Write-up:Information was received from Sanofi Pasteur (manufacturer control # 2016010903) as part of a business agreement on 28-OCT-2016. This case was received from the RA on 26-OCT-2016 under the reference number GB-MHRA-ADR 23693153. Case received from a consumer/other non health professional. A 15-year-old female adolescent patient received GARDASIL, (batch number unknown) via parenteral route on 24-MAR-2014, GARDAIL, (batch number unknown) via parenteral route on 28-JUL-2014. The patient received concomitant administration of: -Baclofen on an unknown date, -Azithromycin on an unknown date, -Lansoprazole on an unknown date. The patient was firstly bed ridden after second was told this was unusual (onset date 24-MAR-2014). She also experienced Epstein-Barre virus infection and post viral fatigue syndrome on an unknown date. The patient had a medical history of immunodeficiency common variable. The patient''s outcome was reported as Not Recovered/Not Resolved.


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