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This is VAERS ID 507878

Case Details

VAERS ID: 507878 (history)  
Age: 13.0  
Gender: Female  
Location: Foreign  
Vaccinated:2011-05-09
Onset:2013-05-20
   Days after vaccination:742
Submitted: 2013-10-15
   Days after onset:148
Entered: 2013-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Borrelia test negative, CSF test normal, Sudden hearing loss
SMQs:, Hearing impairment (narrow)

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Immunisation
Preexisting Conditions: 01/28/2011, GARDASIL, Drug Indication: Immunisation, batch number NN02290; 05/21/2010, GARDASIL, Drug Indication: Immunisation, batch number NL45420
Diagnostic Lab Data: A negative borrelia test including a cerebrospinal fluid test was performed on an unspecified date.
CDC Split Type: WAES1310DNK006354

Write-up: Case received from health care professional via Health Authority in a foreign country on 04-Oct-2013 under the reference numbers 22256262 and EFO7020. The primary reporter was a physician. Case is medically confirmed. A 15 year old female patient (weight:52 kg; height: 160 cm), had received the third dose of GARDASIL (batch number NN02290) via intramuscular route of administration in not reported site of administration on 09-May-2011 and later on 20-May-2013 she developed sudden deafness on the right ear. The Health Authority was in contact with the physician on 26-Sep-2013. A negative borrelia test including a cerebrospinal fluid test was performed on an unspecified date. The patient had no other medications. The patient had a history of vaccination with the first and second dose of GARDASIL (batch number NL45420 and NN02290) respectively) via intramuscular route of administration and not reported site of administration on 21-May-2010 and 28-Jan-2011. At the time of reporting, the patient had not recovered.


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