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This is VAERS ID 426718

Case Details

VAERS ID: 426718 (history)  
Form: Version 1.0  
Age: 16.0  
Gender: Female  
Location: California  
Vaccinated:2011-06-21
Onset:2011-06-21
   Days after vaccination:0
Submitted: 2011-07-01
   Days after onset:10
Entered: 2011-07-05
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1017Z / 1 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Activities of daily living impaired, Asthenia, Dizziness, Headache, Nausea, Somnolence, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol; FLONASE; ADVAIR
Current Illness: Asthma; Rhinitis allergic
Preexisting Conditions: Uterine bleeding
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES1106USA03334

Write-up: Information has been received from a licensed visiting nurse concerning a 16 year old female patient with asthma, allergic rhinitis, no drug reactions or allergies and a history of uterine bleeding, who on 21-JUN-2011 was vaccinated with the first dose of GARDASIL intramuscularly (Lot number 1017Z). No other vaccines were administered concomitantly. Concomitant therapy included FLONASE, ADVAIR and albuterol (manufacturer unknown). The licensed visiting nurse reported that on 21-JUN-2011, later that day the patient developed headache, dizziness, nausea, vomiting, weakness for two days and sleepiness. On 24-JUN-2011 the patient was seen by a physician at a health center and he recommended that the patient received no more GARDASIL vaccinations. No lab diagnostics studies were performed. TYLENOL was given as a treatment for the experience. At the time of the report, the patient had fully recovered (date not provided). Headache, dizziness, nausea, vomiting, weakness for two days and sleepiness were considered to be temporarily disabling by the licensed practical nurse since the patient missed days of school. Additional information has been requested.


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