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This is VAERS ID 456857

Case Details

VAERS ID: 456857 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: Oregon  
Vaccinated:2007-12-05
Onset:2008-07-01
   Days after vaccination:209
Submitted: 2012-06-01
   Days after onset:1431
Entered: 2012-06-06
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 500576P / 1 NS / IN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1063U / 1 AR / SYR

Administered by: Private       Purchased by: Private
Symptoms: Abdominal pain upper, Back pain, Blindness, Convulsion, Gene mutation identification test
SMQs:, Acute pancreatitis (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 54 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Gene mutation Polg.
CDC Split Type:

Write-up: GARDASIL vaccine giving 12/5/07 and second injection 3/5/08. Chronic stomach pain noted for several months. Dr seen 10/24/08 for stomach pain. 3rd GARDASIL shot giving 11/12/08. Chronic stomach pain continues medical involvement continues for stomach pain. Patient seen 5/09 for severe back pain. Stomach pain continues until April 6, 2010 when patient stricken with seizures, hospitalization, blindness.


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