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This is VAERS ID 421085

History of Changes from the VAERS Wayback Machine

First Appeared on 5/13/2011

VAERS ID: 421085
Age:
Gender:Female
Location:Unknown
Vaccinated:2011-03-01
Onset:2011-03-01
Submitted:2011-04-13
Entered:2011-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Amnesia, Fall, Head injury, Loss of consciousness, Speech disorder

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown
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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