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This is VAERS ID 343030

Case Details

VAERS ID: 343030 (history)  
Age: 16.0  
Gender: Female  
Location: Foreign  
Vaccinated:2007-10-11
Onset:2008-01-11
   Days after vaccination:92
Submitted: 2009-03-30
   Days after onset:443
Entered: 2009-03-31
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / UN

Administered by: Unknown       Purchased by: Unknown
Symptoms: Anaphylactic shock, No reaction on previous exposure to drug, Psychotic disorder
SMQs:, Anaphylactic reaction (narrow), Systemic lupus erythematosus (broad), Anaphylactic/anaphylactoid shock conditions (narrow), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (broad), Hypersensitivity (narrow)

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Developmental delay
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0903USA04762

Write-up: Information has been received from a health authority (reference number PEI2009004916) via a physician concerning a 16 year old female with a history of developmental delay who was vaccinated with a second dose of GARDASIL (lot # and injection site not reported) IM on 10-JAN-2008. One day p.v., on 11-JAN-2008, the patient experienced an allergic shock. Subsequently she developed an unspecified psychosis. She was hospitalized for ten weeks and recovered "with sequelae" (not specified). First vaccination with GARDASIL on 11-OCT-2007 was well tolerated. Other business partner numbers included: E2009-02497. No further information is available. File closed.


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