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This is VAERS ID 516644

Case Details

VAERS ID: 516644 (history)  
Form: Version 1.0  
Gender: Male  
Location: Arizona  
Submitted: 2013-12-16
Entered: 2013-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Activities of daily living impaired, Headache, Migraine
SMQs:, Dementia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1312USA005382

Write-up: This spontaneous report as received from nurse practitioner (as informed by the mother of an unspecified patient) refers to a male patient of unknown age. No medical history was reported. On an unknown date, the patient was vaccinated with a second dose of GARDASIL (lot#, route of administration, dosage were not reported). No concomitant medication was reported. On an unknown date, the patient experienced a severe headache, a migraine after receiving the second dose of GARDASIL. The patient sought medical attention. The patient was seen in the emergency room. The headache lasted for one week and the patient was unable to attend school. It was also reported by the physician that the headache was severe. On an unspecified date, headache was resolved and the outcome of migraine was unknown. The event severe headache was considered serious as it had caused disability (patient was unable to attend school). Additional information has been requested.

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