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| VAERS ID: | 262096 | Vaccination Date: | 2006-08-14 | | Age: | 17.0 | Onset Date: | 2006-08-14 Days later: 0 | | Gender: | Female | Submitted: | 2006-08-21 | | State: | New York | Entered: | 2006-08-25 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? Yes | | ER or Doctor Visit? No |
| Hospitalized? No | | Current Illness: NONE | | Diagnostic Lab Data: | | Previous Vaccinations: | | Other Medications: | | Preexisting Conditions: NONE | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | HPV4 | MERCK & CO. INC. | 0637C | 0 | IM | RA | |
| Administered by: Private Purchased by: Private | | Symptoms: Asthenia, Chills, Cyanosis, Dizziness, Pallor, Pyrexia, Visual disturbance | | Write-up: 1 hr after vaccination, pt reported to feel dizzy, weak, vision went black for a few seconds, got pale with purple lips x 1/2hr. Felt better after drinking OJ. Then got temp 101F and chills x 1 day. |
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| VAERS ID: | 262242 | Vaccination Date: | 2006-08-23 | | Age: | 14.0 | Onset Date: | 2006-08-23 Days later: 0 | | Gender: | Female | Submitted: | 2006-08-28 | | State: | Washington | Entered: | 2006-08-29 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? Yes | | ER or Doctor Visit? Yes |
| Hospitalized? No | | Current Illness: NONE | | Diagnostic Lab Data: | | Previous Vaccinations: | | Other Medications: | | Preexisting Conditions: NONE | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | HEPA | MERCK & CO. INC. | 0706R | 1 | IM | LA | | HPV4 | MERCK & CO. INC. | 0637F | 0 | IM | LA | |
| Administered by: Private Purchased by: Private | | Symptoms: Fall, Fracture, Syncope vasovagal | | Write-up: Vasovagal syncope shortly after receiving hep A and Gardasil vaccine, fell, hit nose on a drawer, loss of consciousness, sent to ER in transport broke nose. |
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| VAERS ID: | 262243 | Vaccination Date: | 2006-07-25 | | Age: | 16.0 | Onset Date: | 2006-07-25 Days later: 0 | | Gender: | Female | Submitted: | 2006-08-28 | | State: | Washington | Entered: | 2006-08-29 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? Yes | | ER or Doctor Visit? Yes |
| Hospitalized? No | | Current Illness: NONE | | Diagnostic Lab Data: MRI next AM nl | | Previous Vaccinations: | | Other Medications: | | Preexisting Conditions: NONE | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | HPV4 | MERCK & CO. INC. | 0637F | 0 | IM | RA | |
| Administered by: Private Purchased by: Private | | Symptoms: Injury, Syncope, Tremor | | Write-up: Vaccine given after physical. Pt fainted, vasovagal, hit head on carpeted cement floor. Loss of consciousness 1 min, had tonic posturing of right hand only some shaking. |
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| VAERS ID: | 262451 | Vaccination Date: | 2006-08-17 | | Age: | 18.0 | Onset Date: | 2006-08-18 Days later: 1 | | Gender: | Female | Submitted: | 2006-08-28 | | State: | California | Entered: | 2006-09-01 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? Yes | | ER or Doctor Visit? Yes |
| Hospitalized? No | | Current Illness: | | Diagnostic Lab Data: | | Previous Vaccinations: | | Other Medications: NONE | | Preexisting Conditions: | | CDC 'Split Type': WAES0608USA04945 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | HPV4 | MERCK & CO. INC. | 0702F | | IM | | |
| Administered by: Other Purchased by: Other | | Symptoms: Rash, Urticaria | | Write-up: Information has been received from a physician and a medical assistant concerning an 18 yr old female with no pertinent medical history or allergies, who on 17Aug06 was vaccinated IM with HPV rL1 6 11 16 18 VLP vaccine (yeast) (0.5ml) (lot 653650/0702F). There was no concomitant therapy. Subsequently, on 18Aug06 the pt developed a rash and hives. It was reported that this was not an injection site rash. The pt presented to her physician's office on 18Aug06 with hives all over her body. She was treated with oral diphenhydramine hydrochloride (Benadryl). It was also reported that the pt went to the ER twice on 19Aug06 and 20Aug06 and was treated with intravenous methylprednisolone sodium succinate (Solu Medrol) for the hives and welts all over her body and was released (it was also reported that the pt was given IV saline). The pt was scheduled to have a follow up visit with her physician within a week. At the time of this report, the pt had not recovered. The rash and generalized urticaria were felt to be other important medical events. Additional information has been requested. |
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| VAERS ID: | 262482 | Vaccination Date: | 2006-07-25 | | Age: | 23.0 | Onset Date: | 2006-07-26 Days later: 1 | | Gender: | Female | Submitted: | 2006-08-31 | | State: | Rhode Island | Entered: | 2006-08-31 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? No | | Current Illness: | | Diagnostic Lab Data: | | Previous Vaccinations: | | Other Medications: | | Preexisting Conditions: | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | HPV4 | MERCK & CO. INC. | | 0 | IM | LA | |
| Administered by: Unknown Purchased by: Unknown | | Symptoms: Fatigue, Feeling hot, Injection site hypersensitivity, Injection site mass, Injection site pain | | Write-up: Hard painful lump at site of injection, red, site is hot to the touch. Pt states feeling "tired & run down" since injection. |
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| VAERS ID: | 262735 | Vaccination Date: | 2006-07-31 | | Age: | 16.0 | Onset Date: | 2006-08-13 Days later: 13 | | Gender: | Female | Submitted: | 2006-09-07 | | State: | Mississippi | Entered: | 2006-09-07 | |
| Life Threatening Illness? Yes |
| Died? No |
| Disability? No |
| Recovered? No | | ER or Doctor Visit? No |
| Hospitalized? Yes, 5 days | | Extended hospital stay? No |
| Current Illness: | | Diagnostic Lab Data: MRI of brain, cervical, thoracic and lumbosacral spine, drug screen, pregnancy test, sed rate, Blood count, blood chemistries, Lumbar Puncture. | | Previous Vaccinations: | | Other Medications: | | Preexisting Conditions: | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | HPV4 | MERCK & CO. INC. | 0697F | 0 | IM | GM | | MNQ | SANOFI PASTEUR | 42107AA | 0 | IM | GM | |
| Administered by: Unknown Purchased by: Unknown | | Symptoms: Guillain-Barre syndrome, Hypoaesthesia, Paraesthesia, Proteinuria, Red blood cell sedimentation rate increased | | Write-up: Vaccine was given on July 31 2006. She began having numbness and tingling in her feet and hands on or around August 13th or 14th, which persisted and slightly worsened until she was seen in our office on August 21st. Her neurological examination was normal, she had an elevated sedimation rate (39), mild protienuria, otherwize normal labs. MRI of her lumbosacral spine showed a (possibly old, chronic) subarachnoid cyst. She was referred to a neurologist and was seen on August 25th and was found to have weakened severely and was admitted to PICU for suspected Guillian-Barre syndrome which was confirmed by lumbar puncture. She was treated with IVIG with rapid improvement and has gone home. She is slowly improving and has residual weakness. Medical records including neurology received/reviewed. Final diagnosis is GBS. Was treated with IVIG as indicated on VAERS form. Per records pt has residual weakness. 12/19/06-progress notes received for and DC Summary DC DX: GBS. |
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| VAERS ID: | 262742 | Vaccination Date: | 2006-08-01 | | Age: | 15.0 | Onset Date: | 2006-08-01 Days later: 0 | | Gender: | Female | Submitted: | 2006-09-05 | | State: | Virginia | Entered: | 2006-09-08 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? Yes | | ER or Doctor Visit? Yes |
| Hospitalized? No | | Current Illness: | | Diagnostic Lab Data: | | Previous Vaccinations: | | Other Medications: | | Preexisting Conditions: | | CDC 'Split Type': WAES0608USA06904 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | HEPA | MERCK & CO. INC. | | | | UN | | HPV4 | MERCK & CO. INC. | | | IM | | | MNQ | AVENTIS PASTEUR | | | | UN | |
| Administered by: Other Purchased by: Other | | Symptoms: Convulsion, Injection site pain | | Write-up: Information has been received from a physician concerning a 15 year old female patient who in August 2006, was vaccinated IM with a dose of HPV rL1 6 11 16 18 VLP vaccine. Prior to administration, the patient received the following concomitant therapy: hepatitis A vaccine and meningococcal ACYW conjugate vaccine. The patient had a mild seizure after receiving HPV rL1 6 11 16 18 VLP vaccine injection. She also complained of a great deal of pain at injection site. Medical attention was sought. It was reported that the patient recovered 1 day after the event. Her mother called the physician at home 1 day after the injections to state that the patient was fine. Upon internal review, mild seizure was considered to be an other important medical event (OMIC). Additional information has been requested. |
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| VAERS ID: | 262743 | Vaccination Date: | 2006-08-22 | | Age: | 17.0 | Onset Date: | 2006-08-23 Days later: 1 | | Gender: | Female | Submitted: | 2006-09-05 | | State: | Unknown | Entered: | 2006-09-08 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? Yes | | ER or Doctor Visit? Yes |
| Hospitalized? No | | Current Illness: | | Diagnostic Lab Data: | | Previous Vaccinations: | | Other Medications: UNK | | Preexisting Conditions: Asthma | | CDC 'Split Type': WAES0608USA05911 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | HPV4 | MERCK & CO. INC. | | | IM | | |
| Administered by: Other Purchased by: Other | | Symptoms: Chest discomfort, Erythema, Oedema peripheral | | Write-up: Information has been received from a nurse concerning her 17 year old daughter with asthma who on 8/22/06 was vaccinated IM with HPV rL1 6 11 16 18 VLP vaccine (0.5ml). On 8/23/06 the patient developed a swollen thumb and her palms became red and hot. The patient later developed a tightness in her chest. The patient was immediately taken to a physician (an allergist who was the mother's employer) who immediately gave the patient a huge dose of cetirizine hydrochloride and acetaminophen as an intervention. The patient was not hospitalized and did not got to the emergency room. It was unknown if the affected site was the same arm that the vaccine was given in. The patient subsequently recovered from the red and hot palms, swollen thumb, and chest tightness on an unspecified date. The red and hot palms, swollen thumb and chest tightness were felt to be other important medical events. Additional information has been requested. |
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| VAERS ID: | 262785 | Vaccination Date: | 2006-08-10 | | Age: | 19.0 | Onset Date: | 2006-08-15 Days later: 5 | | Gender: | Female | Submitted: | 2006-09-08 | | State: | Texas | Entered: | 2006-09-08 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? Yes | | ER or Doctor Visit? No |
| Hospitalized? No | | Current Illness: NONE | | Diagnostic Lab Data: | | Previous Vaccinations: | | Other Medications: NONE | | Preexisting Conditions: NONE | | CDC 'Split Type': | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | HPV4 | MERCK & CO. INC. | 0702F | 0 | IM | LA | |
| Administered by: Private Purchased by: Private | | Symptoms: Movement disorder | | Write-up: 09/01/06 pt call with c/o decreased ROM in L arm 5 days after injection administration to current date. Tx with Naproxen x 10 days and Tylenol #3. |
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| VAERS ID: | 262809 | Vaccination Date: | 2006-08-23 | | Age: | 17.0 | Onset Date: | 2006-08-27 Days later: 4 | | Gender: | Female | Submitted: | 2006-09-06 | | State: | Georga | Entered: | 2006-09-11 | |
| Life Threatening Illness? No |
| Died? No |
| Disability? No |
| Recovered? Yes | | ER or Doctor Visit? Yes |
| Hospitalized? No | | Current Illness: | | Diagnostic Lab Data: Computed axial 8/29/06 lump having 2 smaller and 1 larger lymph nodes involved. LABS: all WNL. CT of chest/abd/pelvis revealed 14mm circumscribed noe in left supraclavicular node & several less than 1 cm nodes in bilateral axillary areas | | Previous Vaccinations: | | Other Medications: NONE | | Preexisting Conditions: Sulfonamide allergy | | CDC 'Split Type': WAES0608USA06930 | |
| Vaccination | Manufacturer | Lot | Dose | Route | Site | | HPV4 | MERCK & CO. INC. | 0689F | | IM | UN | |
| Administered by: Other Purchased by: Other | | Symptoms: Hypokinesia, Lymphadenopathy, Skin nodule | | Write-up: Information had been received from a healthcare worker concerning a 17 year old female pt with a sulfonamide allergy who on 8/23/06 was vaccinated IM in left upper arm with a dose of HPV rL1 6 11 16 18 VLP vaccine yeast, lot 653736/089F. There was no concomitant medication. it was reported that 5 days after vaccination, on 8/27/06, the pt developed lymph node swelling in the clavicle area, described as grape size. The pt complained of interference of upper arm movement and felt something was present in the clavicle area. Unspecified blood work was done. On 8/29/06 a CAT scan was performed and lump was described as having 2 smaller and 1 larger lymph nodes involved. On 8/30/06 the pt was scheduled for surgery to have the lymph nodes removed and biopsied. As of the report date, the pt had not recovered. The reporter felt that the lymph node swelling and interference with upper arm movement were other important medical events (OMIC). Additional information has been requested. 10/13/06 Received medical records from hospital which reeal patient seen in ER 8/29/06 for enlarged lymph node left supraclavicular area which was tender to palpation. Final Dx: lymphadenopathy. 8/31/06 surgical biopsy done of left node & several other lymph nodes were palpated & sent to lab. |
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