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This is VAERS ID 452339

Case Details

VAERS ID: 452339 (history)  
Age: 12.0  
Gender: Female  
Location: Foreign  
Vaccinated:2010-06-23
Onset:2010-07-26
   Days after vaccination:33
Submitted: 2012-03-22
   Days after onset:605
Entered: 2012-03-23
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. NJ51180 / 1 UN / IM
MMR: MEASLES + MUMPS + RUBELLA (PRIORIX) / GLAXOSMITHKLINE BIOLOGICALS A69CC192A / 1 UN / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Type 1 diabetes mellitus
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow)

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness:
Preexisting Conditions: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1203USA01785

Write-up: Case received from Health Authority (case n. 160894) through SPMSD (local case n. IT127/12). Initial report received from a physician on 12-MAR-2012. Case medically confirmed. A 12 year old female patient was vaccinated on 23-JUN-2010 with the second dose of GARDASIL (batch number reported as: NM18240, lot number: NJ51180) IM (dose was not reported), the patient had also been vaccinated on 20-MAY-2010 with the second dose of PRIORIX (Mfr. GSK, batch n A69CC192A), SC. On 26-JUL-2010 she was diagnosed with Type I diabetes mellitus, she was hospitalized and started on insulin therapy. At the time of reporting she had not recovered. The final outcome was not reported. Upon internal review the company judged relevant to and seriousness criteria hospitalization which was mentioned by the HA in the narrative. The case is closed. The event was also reported to be disabling. The other business partner numbers include E2012-01720.


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