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This is VAERS ID 504178

Case Details

VAERS ID: 504178 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
Vaccinated:2009-05-13
Onset:2011-01-01
   Days after vaccination:598
Submitted: 2013-09-25
   Days after onset:997
Entered: 2013-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0773X / UNK UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Connective tissue disorder
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Immunisation
Preexisting Conditions: 03/04/2009, GARDASIL, Immunisation
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1309DNK008362

Write-up: Case received from a health care professional via the Health Authorities on 12-Sep-2013 under the references DK-DKMA-ADR 22238048 and DK-DKMA-EFO6818. Case is medically confirmed. A 14-year-old female patient had received a dose of GARDASIL, (batch number NK05560, lot number 0773X, expiration date 16-JUN-2011) IM on 13-May-2009. On 01-Jan-2011, the patient developed connective tissue disorder. Investigations were performed, but not specified. No other vaccines were given. At the time of reporting, the patient had not recovered. The patient received D1 of GARDASIL on 04-Mar-2009 (batch no. not reported). Toleration was not reported.


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