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This is VAERS ID 408846

Case Details

VAERS ID: 408846 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Texas  
Vaccinated:2010-06-08
Onset:2010-06-09
   Days after vaccination:1
Submitted: 2010-11-15
   Days after onset:159
Entered: 2010-11-16
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0416Z / UNK LA / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1013Y / 1 LA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3335AA / UNK RA / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3382AA / UNK RA / UN

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain upper, Activities of daily living impaired, Arthralgia, Arthritis infective, Blood test, Constipation, Flank pain, Lymphadenitis, Pain
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1011USA00698

Write-up: Information has been received from a physician concerning a 12 year old female patient with no pertinent medical history and no drug reactions/allergies, who on 08-JUN-2010 was vaccinated with the first dose of GARDASIL (Lot # 662304/1013Y). Concomitant therapy included VAQTA (Lot # 667827/0416Z), diphtheria toxoid (+) pertussis acellular vaccine (unspecified) (+) tetanus toxoid and MENACTRA. On 09-JUN-2010 the patient experienced severe stomach ache, constipation, pain on the right side and joint pain after receiving GARDASIL. The patient went to ER and the final diagnosis was mesenteric adenitis with post infectious arthritis and was hospitalized. The patient had some blood tests performed (results not provided). At the time of the report, the patient''s arthritis continued and the outcome for mesenteric adenitis was unknown. The physician said that experience was considered to be disabling as it had kept the patient from participating in sports. Additional information has been requested.


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