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This is VAERS ID 296065

Case Details

VAERS ID: 296065 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: Idaho  
   Days after vaccination:5
Submitted: 2007-11-07
   Days after onset:21
Entered: 2007-11-08
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Headache, Nausea, Paraesthesia, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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 PMH: recurrent otitis media & otitis externa. Depression, self mutilation & prior suicide attempts. Childhood sexual abuse & rape w/flashbacks. Mildly obese. Allergic: sulfa. MVA 3 yrs prior w/lingering HA.
Diagnostic Lab Data: Unknown LABS: abnormal Pap smear 10/30. CBC, chemistry & thyroid WNL.
CDC Split Type: WAES0710USA05278

Write-up: Information has been received from a physician''s assistant concerning a 15 year old female who on approximately 17-OCT-2007 was vaccinated with a 0.5 ml dose of Gardasil. On approximately 17-OCT-2007 the patient experienced headache, extreme nausea, vomiting and tingling in fingers and toes. It was reported that the patient missed 2 days of school. At the time of the report, the patient was recovering. The reporting physician''s assistant considered headache, extreme nausea, vomiting and tingling in fingers and toes to be disabling. Additional information has been requested. 11/27/07 Received vax record from pcp. 2/8/08 Reviewed pcp medical records which reveal patient experienced URI s/s, cough, sore throat, bronchitis, otitis media & otitis externa approx 2 wks prior to vax & was on antibiotics. Seen in office 10/16 c/o HA & nausea beginning 48 hr s/p vax. Improved when seen next on 10/23 but bilat otitis externa had recurred.

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