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This is VAERS ID 271366

Case Details

VAERS ID: 271366 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Unknown  
Location: Connecticut  
Vaccinated:2006-11-10
Onset:2006-11-11
   Days after vaccination:1
Submitted: 2007-01-26
   Days after onset:76
Entered: 2007-01-29
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0955F / UNK UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Condition aggravated, Crohn's disease
SMQs:, Gastrointestinal premalignant disorders (narrow), Ischaemic colitis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Crohn''s disease
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: WAES0701USA03418

Write-up: Information has been received from a physician concerning a patient (age and gender unknown) with Crohn''s disease who on 10-NOV-2006 was vaccinated intramuscularly with a 0.5 mL dose of Gardasil vaccine (yeast) (Lot # 653978/0955F). On 11-NOV-2006 the patient had a flair up of Crohn''s disease after receiving the Gardasil vaccine (yeast). The flair up was so severe that the patient had to be out of school for a month. The patient sought unspecified medical attention. No product quality complaint was involved. At the time of this report, the patient was recovering. The flair up of Crohn''s disease was considered to be disabling. Additional information has been requested.


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