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This is VAERS ID 293736

Case Details

VAERS ID: 293736 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: New York  
Vaccinated:2007-10-04
Onset:2007-10-06
   Days after vaccination:2
Submitted: 2007-10-18
   Days after onset:12
Entered: 2007-10-19
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0187U / 1 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Aneurysm, Haemorrhage intracranial, Headache, Surgery, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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, 21 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown 11/9/07-records received-CT evidence of intraventricular bleed in frontal horns of lateral vetricles bilaterally with clot extending to foreman no monro bilaterally with evidence of hydrocephalus dilated lateral ventricles bilaterally. evidence of bleed in third ventricle and fourth ventricle evidence of probable subarachnoid hemorrhage in basal cisterns and sylvian cisterns bilaterally. 12/06/07-records received- PEG placement for failed swallow study. VEEG negative for seizures.
CDC Split Type: WAES0710USA02452

Write-up: Information has been received from a physician concerning a 13 year old female with no relevant medical history reported who on 04-OCT-2007 was vaccinated with the first dose Gardasil (lot 656049/0187U). On 06-OCT-2007, the patient was seen at the office complaining of severe headache and vomiting. The patient was transferred to the hospital by ambulance and was admitted. A diagnosis of cranial bleeding due to an aneurysm was made. The patient underwent surgery. At the time of reporting, the patient was recovering. The patient''s aneurysm and intracranial bleeding were considered disabling, immediately life-threatening, and other important medical events. Additional information has been requested. 11/09/07-records received for DOS 10/6/07-seen in ED of transfering facility-Acute 4 hour onset o occipital headache, constant crescendo-decresendo. Nausea vomiting, Headache exacerbated with movement of head, radiating to neck. Awake, alert, oriented X3. 12/06/07-records received from receiving facility for DOS 10/09-10/31/07-DC DX:SAH/IVH secondary to right paravermian/posterior fossa AVM. Procedure:angio cerebral artery-and suboccipital craniectomy, resection of tumor, surgical resection placement of VP shunt. Transferred to rehabilitation facility


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