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This is VAERS ID 358667

Case Details

VAERS ID: 358667 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: North Carolina  
   Days after vaccination:76
Submitted: 2009-09-28
   Days after onset:14
Entered: 2009-09-29
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Abdominal pain upper, Blood test normal, Computerised tomogram normal, Epstein-Barr virus test positive, Nuclear magnetic resonance imaging normal
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Diagnostic Lab Data: Diagnostic laboratory, 09/19/09, Blood work was normal; Computed axial, 09/19/09, normal; Magnetic resonance, 09/19/09, abdominal: normal; Serum Epstein-Barr, 09/19?/09, positive
CDC Split Type: WAES0909USA03143

Write-up: Information has been received from a physician concerning his 16 year old daughter with no pertinent medical history and no known drug allergies who on 30-JUN-2009 was vaccinated IM with a first 0.5ml dose of GARDASIL (lot# not reported). There was no concomitant medication. On 14-SEP-2009 the patient experienced severe, crampy, intermittent left upper abdominal quadrant pain. On 19-SEP-2009 the patient was admitted to hospital. Blood work, computed axial tomography (CT) scan, and abdominal magnetic resonance imaging (MRI) were normal. The test results on the patient came back as positive for Epstein Barr virus. The patient received pain management with hydrocodone and intravenous morphine. The patient was discharged on 20-SEP-2009. At the time of the report, the patient had not recovered. Severe, crampy, intermittent left upper abdominal quadrant pain and positive for epstein barr virus were considered to be disabling. Additional information has been requested.

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