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From the 11/26/2021 release of VAERS data:

This is VAERS ID 453908

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Case Details

VAERS ID: 453908 (history)  
Form: Version 1.0  
Age: 14.0  
Sex: Male  
Location: Washington  
Vaccinated:2011-08-30
Onset:2012-04-12
   Days after vaccination:226
Submitted: 2012-04-16
   Days after onset:4
Entered: 2012-04-17
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA113AA / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3846AA / 1 LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Asthma, Blood glucose increased, Cachexia, Condition aggravated, Cough, Dehydration, Diarrhoea, Glucose urine present, Polydipsia, Polyuria, Type 1 diabetes mellitus, Urine ketone body present, Weight decreased, Wrong drug administered
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tubulointerstitial diseases (broad), Medication errors (narrow), Dehydration (narrow), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Mild asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Per mother since vaccination, pt started to lose weight & was diagnosed with Type I DM 4/12/12, concerned because pt was given CERVARIX in error.


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