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This is VAERS ID 494392

Case Details

VAERS ID: 494392 (history)  
Age: 15.0  
Gender: Female  
Location: Foreign  
Vaccinated:2011-10-31
Onset:2011-12-01
   Days after vaccination:31
Submitted: 2013-06-18
   Days after onset:564
Entered: 2013-06-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. NM26350 / 2 LA / UN

Administered by: Other       Purchased by: Other
Symptoms: Headache, Polyarthritis, Serology abnormal, X-ray abnormal
SMQs:, Systemic lupus erythematosus (broad), Arthritis (narrow)

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Immunisation
Preexisting Conditions: 07/2011, Abdominal distension, lasting for 3-4 months; 07/2011, Headache, lasting for 3-4 months; 07/2011, Abdominal pain, lasting for 3-4 months; 06/20/2011, GARDASIL, Abdominal distension; 06/20/2011, GARDASIL, Headache; 06/20/2011, GARDASIL, Abdominal pain, D2 of GARDASIL (lot-no. NP12170) was given into the left upper arm on 20-JUN-2011; 04/11/2011, GARDASIL, D1 of GARDASIL (lot-no. NL31810, this batch was imported from another country and not released by HA) was given into the left upper arm on 11-Apr-2011 and was well tolerated, No adverse event
Diagnostic Lab Data: In Dec-2011, the patient developed headache and polyarthritis. Diagnosis was confirmed by serology and X-ray (not further specified)
CDC Split Type: WAES1306DEU006752

Write-up: Case was received from the Health Authorities on 07-Jun-2013 (reference no. PEI2013031797). Case is medically confirmed. This case is linked to E2013-04281 (same patient, same reporter, same vaccine). A 15-year-old female patient received the third dose of GARDASIL (lot-no. NP39700) into the left upper arm on 31-Oct-2011. On an unspecified date in Dec-2011, the patient developed headache and polyarthritis. Diagnosis was confirmed by serology and X-ray (not further specified). The patient received unspecified outpatient treatment. At the time of reporting the patient had not recovered. It was reported, that the patient had lasting damage from the vaccination. D1 of GARDASIL (lot-no. NL31810, this batch was imported from another country and not released by HA) was given into the left upper arm on 11-Apr-2011 and was well tolerated. D2 of GARDASIL (lot-no. NP12170) was given into the left upper arm on 20-Jun-2011. In Jul-2011 the patient developed abdominal pain, headache and bloating, lasting for 3-4 months. During medical review the company considered to additionally select "Disability" as a seriousness criterion. Lasting damage was mentioned in the report, but not coded by HA.


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