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This is VAERS ID 398145

Case Details

VAERS ID: 398145 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Foreign  
Submitted: 2010-09-13
Entered: 2010-09-14
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: Unknown
Symptoms: Encephalitis
SMQs:, Noninfectious encephalitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1009USA00838

Write-up: Information has been received from a Health Authority (reference # ADR20657398) concerning a 13 year old female patient with unreported medical history who on 14-OCT-2009 was vaccinated intramuscularly with the first dose of GARDASIL (manufacturer, batch # not reported and site not reported). On 13-NOV-2009, the patient was vaccinated intramuscularly with the second dose of GARDASIL (manufacturer, batch # not reported and site not reported) and experienced N-Methyl-D-Aspartate Receptor (NDA) encephalitis and was hospitalized. On an unreported date, the patient became symptomatic either in the same month as the patient received the first dose and onwards or three days prior to admission to the hospital. The patient was confirmed to have N-Methyl-D-Aspartate Receptor (NDA) encephalitis. A third dose of GARDASIL was not given. The patient was recovering at the time of reporting. According to the reporter and the agency the event was considered serious as it was life-threatening, hospitalization and disabling/incapacity. The agency coded the event of encephalitis. This case is medically confirmed. Other business partner numbers include E2010-05321. No further information is available.

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