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This is VAERS ID 269211

Case Details

VAERS ID: 269211 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Tennessee  
Vaccinated:2006-11-14
Onset:2006-11-15
   Days after vaccination:1
Submitted: 2006-12-14
   Days after onset:29
Entered: 2006-12-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / UNK - / -

Administered by: Private       Purchased by: Other
Symptoms: Abnormal behaviour, Euphoric mood, Malaise, Nausea
SMQs:, Acute pancreatitis (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Penicillin allergy, drug hypersensitivity
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: WAES0611USA05160

Write-up: Information has been received from a registered nurse concerning a 13 year old female with a penicillin allergy and drug hypersensitivity to Zithromax. On 14 Nov 2006, the patient was vaccinated with Gardasil (yeast) ( Lot # 653978/0955F). There were no concomitant medications reported. On 15 Nov 2006, the patient was noted to be very emotional, nauseated, felt dazed and "high". The patient sought unspecified medical attention. No treatment was required. On 16 Nov 2006, the patient had recovered from the events. Additional information has been requested.


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