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This is VAERS ID 426969

Case Details

VAERS ID: 426969 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: New York  
   Days after vaccination:0
Submitted: 2011-07-07
   Days after onset:10
Entered: 2011-07-08
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Anxiety, Face injury, Fall, Laceration, Seizure like phenomena
SMQs:, Convulsions (narrow), Accidents and injuries (narrow), Hostility/aggression (broad), Hypoglycaemia (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: Unknown
CDC Split Type: WAES1106USA03859

Write-up: Information has been received from a physician concerning a 13 year old female who on 27-JUN-2011 was vaccinated intramuscularly with the first dose of GARDASIL. The reporter stated on 27-JUN-2011, the patient experienced seizure like symptoms. She was sitting on the exam table, fell off the table and hit her chin on the counter as she fell. The patient was anxious and had not eaten all day. The patient split her chin open and it was considered to be disabling. At the time of the report, the patient''s outcome was unknown. The patient sought unspecified medical attention. Upon internal review, seizure like symptoms is considered to be other important medical event. Additional information has been requested.

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