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This is VAERS ID 290580

Case Details

VAERS ID: 290580 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: Unknown  
Vaccinated:2007-05-16
Onset:2007-08-23
   Days after vaccination:99
Submitted: 2007-09-13
   Days after onset:21
Entered: 2007-09-14
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0388U / 1 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Asthenia, Fatigue, Mental status changes
SMQs:, Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0709USA00835

Write-up: Information has been received from a nurse concerning a 15 year old female who on 16-MAY-2007 was vaccinated with a first dose of Gardasil (lot 657622/0388U). On 16-MAY-2007, the patient was concomitantly vaccinated with hepatitis A vaccine (inactive) (manufacturer unknown). The nurse reported that the patient stated that she received a second dose of Gardasil, but the nurse noted that there was no documentation that the patient received a second dose of Gardasil. On 23-AUG-2007 the patient experienced fatigue, altered mental status and weakness. On 25-AUG-2007, the patient was brought to the emergency room. The patient was hospitalized (details and length of hospitalization not provided). The patient was visited by her physician on 25-AUG-2007, 26-AUG-2007, and 28-AUG-2007. At the time of this report, the outcome was unknown. Additional information has been requested.


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