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This is VAERS ID 382351

Case Details

VAERS ID: 382351 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Texas  
Submitted: 2010-03-10
Entered: 2010-03-11
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Activities of daily living impaired, Asthenia, Laboratory test, Pain, Similar reaction on previous exposure to drug
SMQs:, Dementia (broad), Guillain-Barre syndrome (broad)

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:
Current Illness:
Preexisting Conditions: Immunisation
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1003USA00592

Write-up: Information has been received from a physician and a medical assistant concerning a 13 year old female patient who on 06-MAY-2009 was vaccinated with the first 0.5 ml dose of GARDASIL (Lot # 658282/0929U) concomitantly with a dose of MENACTRA (Lot # UF389AA). On 04-AUG-2009, the patient was vaccinated with the second dose of GARDASIL (Lot # 658282/0929U) and on 19-JAN-2010, the patient was vaccinated with the third dose of GARDASIL (Lot # 658282/0929U). According to the physician, after the patient received her third dose of GARDASIL, she reported that she was extremely sore and weak. The medical assistant reported that the patient had a physician''s note to be out of school on 25-JAN-2010 and remained out of school for the rest of that week (until approximately 29-JAN-2010) for symptoms of being extremely sore and weak, it was also reported that the patient had another note to be out of school for symptoms of extremely sore and weak from 01-MAR-2010 to 12-MAR-2010 (also reported by the physician as "missed 2 months of school"). The physician also mentioned that the patient had "mild symptoms" following the first and second dose of GARDASIL (dates not reported). The medical assistant stated that the patient had not recovered. The patient sought unspecified medical attention. Diagnostic laboratories test were performed (not results provided). Upon internal review the patient remained out of school for symptoms of being extremely sore and weak, was considered disabling. Additional information has been requested.

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