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This is VAERS ID 299033

Case Details

VAERS ID: 299033 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Foreign  
Vaccinated:2007-05-30
Onset:2007-09-19
   Days after vaccination:112
Submitted: 2007-12-06
   Days after onset:78
Entered: 2007-12-07
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 3 UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Crohn's disease, Intestinal perforation, Peritonitis
SMQs:, Gastrointestinal premalignant disorders (narrow), Gastrointestinal perforation (narrow), Ischaemic colitis (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 0 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0712USA01297

Write-up: Information has been received from a physician, concerning a 15 year old female patient, who in December 2006 was vaccinated with the first dose, in January 2007 with the second dose, and on 30-MAY-2007 with the third dose of Gardasil (lot #654740/0859F; batch NE26610). On 19-SEP-2007, approximately 3 and 1/2 months after the third vaccination, the patient experienced peritonitis, secondary to perforation of the small intestine, and was hospitalized. A diagnosis of Crohn''s disease was determined. The patient had not prior history of related symptoms before the events occurred. At the time of this report, the patient had not recovered from the events. The reporting physician felt that Crohn''s disease was possibly induced by therapy with Gardasil. The physician considered the events to be immediately life-threatening, and significantly disabling/incapacitating. Other business partner numbers included: E2007-08859.


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