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This is VAERS ID 415253

Case Details

VAERS ID: 415253 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Texas  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2011-01-21
Entered: 2011-01-24
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1101USA01378

Write-up: Information has been received from a physician concerning a 15 year old female patient he heard about (it was unknown if this was a patient of a clinical colleague or an acquaintance of him), that "was healthy as a horse" who on an unspecified date was vaccinated with GARDASIL (it is unknown which dose this was in the series). The physician reported that "within two weeks of administration of the vaccine she is in the hospital with seizures and is a picture of death". At the time of the report, the patient had not recovered. The patient''s symptoms were considered to be disabling and immediately life-threatening by the physician. No further information is available.


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