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This is VAERS ID 421085

Case Details

VAERS ID: 421085 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Unknown  
Vaccinated:2011-03-01
Onset:2011-03-01
   Days after vaccination:0
Submitted: 2011-04-13
   Days after onset:42
Entered: 2011-04-15
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Amnesia, Fall, Head injury, Loss of consciousness, Speech disorder
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1104USA00869

Write-up: Information has been received from a registered nurse concerning a female patient who in March 2011 "sometime in March" was vaccinated with the first 0.5 ml dose of GARDASIL intramuscularly (Lot number not reported). Concomitant therapy included DTAP (unspecified). The nurse reported that in March 2011 "sometime in March" after received the first dose of GARDASIL intramuscularly, the patient experienced passing out, falling and hitting her head. She was taken to an unspecified hospital, received unspecified treatment and stayed there for an unspecified duration. The patient had been released from the hospital and was currently having speech problems and had short term memory loss. Therapy with GARDASIL was discontinued. At the time of the report, outcome of the patient was unknown. It was reported that the patient was not reintroduced to the therapy. Passing out, fall, hitting her head, speech problems and short term memory loss were considered to be disabling. Additional information has been requested.


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