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This is VAERS ID 507878

Case Details

VAERS ID: 507878 (history)  
Form: Version 1.0  
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. - / 3 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
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
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
Allergies:
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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