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This is VAERS ID 421086

Case Details

VAERS ID: 421086 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
   Days after vaccination:1
Submitted: 2011-04-13
   Days after onset:29
Entered: 2011-04-15
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain, Blood albumin decreased, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Serum albumin, nil
CDC Split Type: WAES1104USA01093

Write-up: Information was obtained on a request by the Company from the agency via a Public Case Detail form concerning a 12 year old female patient who on 14-MAR-2011 was vaccinated with first dose of GARDASIL (batch# NK 19970, lot# NJ28270) 0.5ML IM. On unspecified date, the lab results showed albumin nil. On 15-MAR-2011, the patient developed a light rash on the torso only (none on arms/legs/face), and some vague pain in abdomen. The patient was treated with PANADOL, dose for age on 15-MAR-2011 only. On 16-MAR-2011, the rash had gone. The patient was well. It was considered the events was possibly related to GARDASIL. The rash and abdominal pain were considered as incapacity/disability. The original reporting source was not provided. No further information is available.

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