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This is VAERS ID 428658

Case Details

VAERS ID: 428658 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Foreign  
Vaccinated:2011-01-07
Onset:2011-02-02
   Days after vaccination:26
Submitted: 2011-08-02
   Days after onset:180
Entered: 2011-08-03
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. NK01590 / UNK UN / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Encephalitis
SMQs:, Noninfectious encephalitis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1107USA04023

Write-up: Case received from a health care professional via the Health Authorities (HA) on 27-JUL-2011 under the reference number 112663. Case medically confirmed. A 13-year-old female patient had received an injection of GARDASIL (lot number NK01590, batch number NM20720-1, i.m.) on 07-JAN-2011 and later on 02-FEB-2011 she developed encephalitis. The HA reported seriousness criteria as both hospitalization and disability. At the time of reporting, the outcome was recovered with sequel. According to the reporter, the reaction was possibly related to vaccination Other business partner number included E2011-04631. No further information expected.


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