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This is VAERS ID 340833

Case Details

VAERS ID: 340833 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Maine  
Submitted: 2009-02-26
Entered: 2009-02-27
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Activities of daily living impaired, Arthralgia, Back pain, Headache
SMQs:, Retroperitoneal fibrosis (broad), Dementia (broad), Arthritis (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: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0902USA03735

Write-up: Information has been received from a physician concerning a 15 year old female with no medical history and drug allergies who, on an unspecified date, was vaccinated intramuscularly with her first 0.5 ml dose of GARDASIL. There was no concomitant medication. The patient had experienced hip pain, lower back pain and headache after receiving the first dose of GARDASIL. It was noted that she had experienced pain in both of her hips but the left side had more pain than the right. The pain in her hips had made it difficult for the patient to participate in her soccer games. The patient sought medical attention and was seen by physician. The lot numbers and dates of administration were unknown. At the time of reporting (20-FEB-2009) the patient was recovering. The reporter considered the adverse experiences to be disabling. Additional information has been requested.

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