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This is VAERS ID 300497

Case Details

VAERS ID: 300497 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Virginia  
Vaccinated:2007-10-11
Onset:2007-10-21
   Days after vaccination:10
Submitted: 2007-12-14
   Days after onset:54
Entered: 2007-12-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Activities of daily living impaired, Back pain, Borrelia burgdorferi serology, Chest pain, Full blood count, Musculoskeletal pain, Myalgia, Red blood cell sedimentation rate, Rheumatoid factor
SMQs:, Rhabdomyolysis/myopathy (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

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: Penicillin allergy; Sulfonamide allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: complete blood cell - no provided; erythrocyte - not provided; Lyme disease assay - not provided; serum rheumatoid factor - not provided
CDC Split Type: WAES0711USA04684

Write-up: Information has been received from a pharmacist concerning her 15 year old daughter who plays sports, with a penicillin allergy and sulfonamide allergy and no pertinent medical history who in August 2007, was vaccinated with her first dose of Gardasil. On 11-OCT-2007 the patient received her second dose of Gardasil. On 21-OCT-2007, ten days after receiving her second dose, the patient developed myalgia. The patient had unexplained muscle pain which started from her shoulder and traveled to her back and then to her chest. This event was considered to be a significant disability, as she was not able to play basketball. Laboratory tests included: complete blood count, sedimentation rate, lyme disease titer, and a rheumatoid arthritis test (results not reported). The patient''s myalgia persisted. Medical attention was sought, the patient saw the physician. Additional information has been requested.


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