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This is VAERS ID 428658

History of Changes from the VAERS Wayback Machine

First Appeared on 12/14/2011

428658
VAERS Form:
Age:13.0
Gender:Female
Location:Foreign
Vaccinated:2011-01-07
Onset:2011-02-02
Submitted:2011-08-02
Entered:2011-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. NK01590 / - UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Encephalitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) 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.


Changed on 6/14/2014

428658 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Foreign
Vaccinated:2011-01-07
Onset:2011-02-02
Submitted:2011-08-02
Entered:2011-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. NK01590 / - UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Encephalitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) 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.


Changed on 4/14/2017

428658 Before After
VAERS Form:
Age:13.0
Gender:Female
Location:Foreign
Vaccinated:2011-01-07
Onset:2011-02-02
Submitted:2011-08-02
Entered:2011-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. NK01590 / - UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Encephalitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) 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.


Changed on 9/14/2017

428658 Before After
VAERS Form:(blank) 1
Age:13.0
Gender:Female
Location:Foreign
Vaccinated:2011-01-07
Onset:2011-02-02
Submitted:2011-08-02
Entered:2011-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. NK01590 / - UNK UN / IM

Administered by: Unknown      Purchased by: Unknown
Symptoms: Encephalitis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) 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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