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This is VAERS ID 675713

History of Changes from the VAERS Wayback Machine

First Appeared on 1/14/2017

VAERS ID: 675713
VAERS Form:
Age:16.0
Gender:Female
Location:Pennsylvania
Vaccinated:2012-08-24
Onset:2012-10-18
Submitted:2016-12-29
Entered:2016-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H011350 / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4347AA / 1 UN / IM

Administered by: Private      Purchased by: Other
Symptoms: Arthropathy, Autonomic nervous system imbalance, Dystonia, Fatigue, Hypermobility syndrome, Migraine, Orthostatic hypotension, Syncope, Tension headache, Fibromyalgia, Myofascial pain syndrome, Complex regional pain 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 21     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Allergy to morphine and bilateral hearing loss
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Complex Regional Pain Syndrome, Joint Hypermobility Syndrome, Orthostatic Hypotension, Dystonia, Dysautonomia, Tension Headaches, Migraines, Myofascial Pain Syndrome, Fibromyalgia, SI Joint Dysfunction, fatigue, Vasovagal Syncope.


Changed on 2/14/2017

VAERS ID: 675713 Before After
VAERS Form:
Age:16.0
Gender:Female
Location:Pennsylvania
Vaccinated:2012-08-24
Onset:2012-10-18
Submitted:2016-12-29
Entered:2016-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H011350 / 0 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4347AA / 1 UN / IM

Administered by: Private      Purchased by: Other
Symptoms: Arthropathy, Autonomic nervous system imbalance, Dystonia, Fatigue, Hypermobility syndrome, Migraine, Orthostatic hypotension, Syncope, Tension headache, Fibromyalgia, Myofascial pain syndrome, Complex regional pain 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 21 24     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Allergy to morphine and bilateral hearing loss
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Complex Regional Pain Syndrome, Joint Hypermobility Syndrome, Orthostatic Hypotension, Dystonia, Dysautonomia, Tension Headaches, Migraines, Myofascial Pain Syndrome, Fibromyalgia, SI Joint Dysfunction, fatigue, Vasovagal Syncope.


Changed on 9/14/2017

VAERS ID: 675713 Before After
VAERS Form:(blank) 1
Age:16.0
Gender:Female
Location:Pennsylvania
Vaccinated:2012-08-24
Onset:2012-10-18
Submitted:2016-12-29
Entered:2016-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H011350 / 0 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4347AA / 1 2 UN / IM

Administered by: Private      Purchased by: Other
Symptoms: Arthropathy, Autonomic nervous system imbalance, Dystonia, Fatigue, Hypermobility syndrome, Migraine, Orthostatic hypotension, Syncope, Tension headache, Fibromyalgia, Myofascial pain syndrome, Complex regional pain 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 24     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Allergy to morphine and bilateral hearing loss
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Complex Regional Pain Syndrome, Joint Hypermobility Syndrome, Orthostatic Hypotension, Dystonia, Dysautonomia, Tension Headaches, Migraines, Myofascial Pain Syndrome, Fibromyalgia, SI Joint Dysfunction, fatigue, Vasovagal Syncope.


Changed on 2/14/2018

VAERS ID: 675713 Before After
VAERS Form:1
Age:16.0
Gender:Female
Location:Pennsylvania
Vaccinated:2012-08-24
Onset:2012-10-18
Submitted:2016-12-29
Entered:2016-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H011350 / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4347AA / 2 UN / IM

Administered by: Private      Purchased by: Other
Symptoms: Arthropathy, Autonomic nervous system imbalance, Dystonia, Fatigue, Hypermobility syndrome, Migraine, Orthostatic hypotension, Syncope, Tension headache, Fibromyalgia, Myofascial pain syndrome, Complex regional pain 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 24     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Allergy to morphine and bilateral hearing loss
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Complex Regional Pain Syndrome, Joint Hypermobility Syndrome, Orthostatic Hypotension, Dystonia, Dysautonomia, Tension Headaches, Migraines, Myofascial Pain Syndrome, Fibromyalgia, SI Joint Dysfunction, fatigue, Vasovagal Syncope.


Changed on 6/14/2018

VAERS ID: 675713 Before After
VAERS Form:1
Age:16.0
Gender:Female
Location:Pennsylvania
Vaccinated:2012-08-24
Onset:2012-10-18
Submitted:2016-12-29
Entered:2016-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H011350 / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4347AA / 2 UN / IM

Administered by: Private      Purchased by: Other
Symptoms: Arthropathy, Autonomic nervous system imbalance, Dystonia, Fatigue, Hypermobility syndrome, Migraine, Orthostatic hypotension, Syncope, Tension headache, Fibromyalgia, Myofascial pain syndrome, Complex regional pain 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)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 24     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Allergy to morphine and bilateral hearing loss
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Complex Regional Pain Syndrome, Joint Hypermobility Syndrome, Orthostatic Hypotension, Dystonia, Dysautonomia, Tension Headaches, Migraines, Myofascial Pain Syndrome, Fibromyalgia, SI Joint Dysfunction, fatigue, Vasovagal Syncope.

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