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This is VAERS ID 275631

Case Details

VAERS ID: 275631 (history)  
Form: Version 1.0  
Age: 13.0  
Sex: Female  
Location: Pennsylvania  
Submitted: 2007-04-04
Entered: 2007-04-05
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Arthralgia, Dizziness, Headache, Laboratory test, Loss of consciousness, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Hypoglycaemia (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: None
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: diagnostic laboratory - results not reported
CDC Split Type: WAES0703USA05511

Write-up: Information has been received from a physician concerning a 13 year old female who on 18-DEC-2006 was vaccinated with a first dose of Gardasil (lot #654389/0961F). There was no concomitant medication. Subsequently, the patient experienced hip, knee and ankle pain. In January 2007, the patient began to experience occasional episodes of blurry vision. On 02-FEB-2007, the patient was vaccinated with a second dose of Gardasil. It was reported that the patient''s symptoms "severely worsened" following the second dose of Gardasil and the patient also experienced lightheadedness and increase in headaches. The patient was seen by an orthopedic physician on 02-FEB-2007. Unspecified laboratory and diagnostic tests were performed (results not reported). On 07-FEB-2007 the patient experienced "one episode of blacking out." The patient saw a neurologist on 20-MAR-2007. At the time of the report, the patient had not recovered. The reporting physician considered the events to be disabling as the patient was unable to participate in ballet or dancing classes. Additional information has been requested.

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