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This is VAERS ID 343030

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

343030
VAERS Form:
Age:16.0
Gender:Female
Location:Foreign
Vaccinated:2007-10-11
Onset:2008-01-11
Submitted:2009-03-30
Entered:2009-03-31
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Developmental delay
Preexisting Conditions:
Allergies:
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.


Changed on 9/14/2017

343030 Before After
VAERS Form:(blank) 1
Age:16.0
Gender:Female
Location:Foreign
Vaccinated:2007-10-11
Onset:2008-01-11
Submitted:2009-03-30
Entered:2009-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 1 UN / UN

Administered by: Unknown      Purchased by: Unknown
Symptoms: Anaphylactic shock, No reaction on previous exposure to drug, Psychotic disorder

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Developmental delay
Preexisting Conditions:
Allergies:
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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http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=343030&WAYBACKHISTORY=ON


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