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This is VAERS ID 423397

Case Details

VAERS ID: 423397 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
   Days after vaccination:0
Submitted: 2011-05-19
   Days after onset:38
Entered: 2011-05-20
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: Unknown
Symptoms: Dizziness, Headache, Nausea, Somnolence
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Familial risk factor
Preexisting Conditions: Vomiting; Tremor; Syncope; Vomiting; Prostration; Syncope; Tremor; Prostration
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1105USA02444

Write-up: Case received from Health Authorities on 10-MAY-2011 under the reference number L201102-356. Case medically confirmed. A 12-year-old female patient had received the second dose of GARDASIL (batch n.NM14120, lot n. NJ51180 in left deltoid area) via intramuscular route at 12:00 on 11-APR-2011 and in the same day, at 17:00 the patient experienced nausea, dizziness, headache and somnolence that resolved on 12-APR-2011. No relevant clinical history known. Family history: uncle with epilepsy. The patient had previous history of AE to the vaccine against the pandemic flu (manufacturer unknown) on 21-DEC-2009 with vomiting, tremor, fainting and prostration. The patient had also received H1N1 like virus on 21-DEC-2010 via intramuscular route for prophylaxis. The patient had received the first dose of GARDASIL (batch n.NM14120, lot n. NJ51180 in left deltoid area) via intramuscular route on 02-FEB-2011 and post-vaccination the patient presented with lipothymy during seconds, tremor during minutes and vomiting (food content) without other manifestations. The AEs also included prostration during about 1 hour (see case E2011-01255 (WAES #1102USA03388). The patient had fully recovered. Case is closed. the events were considered to be disabling. Other business partner numbers include E2011-02916. No further information is available.

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