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This is VAERS ID 280392

Case Details

VAERS ID: 280392 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Iowa  
Vaccinated:2006-11-01
Onset:2007-05-01
   Days after vaccination:181
Submitted: 2007-06-04
   Days after onset:34
Entered: 2007-06-05
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0187U / 2 UN / UN

Administered by: Private       Purchased by: Private
Symptoms: Autoimmune thrombocytopenia, Evans syndrome, Leukopenia
SMQs:, Haemolytic disorders (narrow), Haematopoietic leukopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Penicillin allergy; Eczematous dermatitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0705USA04412

Write-up: Information has been received from a physician concerning a 15 year old female with penicillin allergy and eczematous dermatitis who on 01-NOV-2006 was vaccinated with a second dose of Gardasil (lot #656049/0187U). On 01-MAY-2007, "roughly at the end of this vaccination series," the patient developed autoimmune thrombocytopenia and leukopenia. The patient was diagnosed with Evan''s Syndrome. The patient was hospitalized for 5 days treated with platelets, immunoglobulin and prednisone. At the time of the report, the patient had not recovered. The reporting physician considered Evan''s syndrome and leukopenia to be immediately life-threatening and disabling events. The reporting physician reported that he was not personally certain the Gardasil of the events. Additional information has been requested.


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