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This is VAERS ID 279633

Case Details

VAERS ID: 279633 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: Georgia  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2007-05-14
Entered: 2007-05-17
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Hallucination, Vaccine positive rechallenge
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (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: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0704USA06235

Write-up: Information has been received from a registered pharmacist concerning an 11 year old female who, on an unspecified date, was vaccinated with a second dose of Gardasil. On 26-APR-2007, the patient was seen in the emergency room for hallucinations. The patient was discharged from the emergency room with instructions to follow-up with her pediatrician. The reporter stated that the patient was "fine" when she left the hospital. It was also noted by the reporter that the patient had reportedly experienced hallucinations after her first dose of Gardasil and was seen in the emergency room of another hospital. The reporter stated that the patient may have received other vaccinations with one or both of the Gardasil vaccine doses. No product quality complaint was involved. Additional information has been requested.


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