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This is VAERS ID 354460

Case Details

VAERS ID: 354460 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
Vaccinated:2009-03-19
Onset:2009-04-07
   Days after vaccination:19
Submitted: 2009-08-17
   Days after onset:132
Entered: 2009-08-18
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asthma exercise induced
SMQs:, Asthma/bronchospasm (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES0908USA01971

Write-up: Information has been received from a health Authority (#DK-DKMA-20091655), concerning a 12 year old female who on 19-Mar-2009 was vaccinated intramuscularly with the first dose of GARDASIL (batch number and site of administration not reported). On 07-Apr-2009 the patient experienced exercise induced asthma. It was reported that the patient had not recovered. The patient had no relevant medical history and received no concomitant medications or vaccine. Asthma exercise induced was considered to be disabling. Other business partner numbers included: E2009-07864. No further information is available.


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