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This is VAERS ID 279674

Case Details

VAERS ID: 279674 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: New Jersey  
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. - / 1 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Amenorrhoea
SMQs:, Fertility disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: WAES0705USA00497

Write-up: Information has been received from a physician concerning a 19 year old female who was vaccinated with a dose of Gardasil. Subsequently the patient developed amenorrhea. Unspecified medical attention was sought. It was reported the patient planned to discontinued the series of injections. Additional information has been requested.


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