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This is VAERS ID 283980

Case Details

VAERS ID: 283980 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Unknown  
Vaccinated:2007-04-10
Onset:2007-04-22
   Days after vaccination:12
Submitted: 2007-06-14
   Days after onset:53
Entered: 2007-06-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0387U / 1 UN / UN

Administered by: Private       Purchased by: Private
Symptoms: Antinuclear antibody, Bacterial test, Blood thyroid stimulating hormone, C-reactive protein, Chest pain, Culture stool, Full blood count, Headache, Laboratory test, Malaise, Oropharyngeal pain, Red blood cell sedimentation rate, Rheumatoid factor, Weight decreased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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; None
Allergies:
Diagnostic Lab Data: Unknown; diagnostic laboratory, serum serotonin- results not reported; complete blood cell, result not reported; serum ANA, results not reported; serum rheumatoid factor, results not reported; erythrocyte, reults not reported; serum C-reactive protein, results not reported; serum TSH, results not reported; stool culture, results not reported; stool for ova and, results not reported; urine bacteria acream, results not reported; total serum thyroxine, results not reported
CDC Split Type: WAES0705USA03075

Write-up: This is in follow-up to report(s) previously submitted on 6/14/2007. Initial and follow-up information has been received from a physician concerning a 15 year old female student, with no pertinent medical history, who on 10-APR-2007 at 16:00, was vaccinated IM in the left arm with a first dose of GARDASIL (lot # 657621/0387U). On 22-APR-2007 at 17:00, the patient experienced significant malaise, sore throat, headache, chest pain, weight loss and nausea. The patient sought unspecified medical attention. Lab tests included complete blood cell count, serum antinuclear antibodies test, serum rheumatoid factor test, erythrocyte sedimentation rate, serum C-reactive protein test, total serum thyroxins test, serum thyroid-stimulating hormone test, stool culture test, serum serotonin, stool for ova and parasites, and urine culture (results not reported). At the time of the report, the symptoms were still present despite appropriate therapy- labs. Additional information is not expected.


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