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This is VAERS ID 274595

Case Details

VAERS ID: 274595 (history)  
Age: 14.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2006-12-20
Onset:2007-01-06
   Days after vaccination:17
Submitted: 2007-03-14
   Days after onset:66
Entered: 2007-03-16
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 654535/0960F / 0 UN / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U1974AB / 0 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Facial palsy, Herpes zoster oticus
SMQs:, Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad)

Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Herpes on lip
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES0702USA04217

Write-up: Information has been received from a registered nurse concerning a 11 year old female who was vaccinated with a dose of Gardasil. Concomitant therapy administered at the same time at a different anatomical site included a dose of MENACTRA. Illness at the time of vaccination included herpes simplex on the lip. On 09-JAN-2007, the patient was seen in the office and was diagnosed with herpes zoster otitis which progressed to a diagnosis of Bell''s palsy and Rasmsay-Hunt Syndrome on 15-JAN-2007. At time of this report, the patient''s outcome was unknown. No product quality complaint was involved. Additional information has been requested. 03/28/07-records received for DOS 1/16/07 DX:Bell''s Palsy. Ramsay Hunt Syndrome. PH:1/9/07-Seen by PMD to treat shingles in right ear with acyclovir. TX stopped on 1/16/07 due to bells palsy. Right side facial droop difficulty eating. C/O headache thoughout with shingles. 1/16/07-stomach cramps, diarrhea. Symptoms resolved 2/8/07. Additional information is not expected.


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