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This is VAERS ID 520691

Case Details

VAERS ID: 520691 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
Submitted: 2014-01-24
   Days after onset:115
Entered: 2014-01-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Acute abdomen, Dyspnoea, Erythema nodosum, Haemorrhagic ovarian cyst, Leukocytosis, Platelet count increased, Thrombocytosis
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: Platelet count (OCT2013) results: Increased (Thrombocytosis)
CDC Split Type: WAES1401SUR011247

Write-up: This spontaneous report as received from a physician refers to a 12 year old female patient. Medical history or concomitant conditions were not reported. On an unknown date, the patient was vaccinated with GARDASIL, 0.5 ml, (frequency reported as: day 1, 2 months after 1st dose, 6 months after 1st. dose), intramuscular (dose was not reported). Concomitant therapy was not reported. In October 2013, the patient was hospitalized due to erythema nodosum, thrombocytosis, leukocytosis and dyspnoea. It was reported that hospitalization was prolonged. On an unknown date, the patient experienced acute abdomen because of bleeding in adnexa cyst which required an emergency room (ER) visit and went to operation room. Leukocyte count was 100 x 10g/L. The outcome of erythema nodosum, thrombocytosis, leukocytosis and dyspnoea was reported as not recovered/not resolved. The outcome of acute abdomen because of bleeding in adnexa cyst was unknown. The reporting physician considered erythema nodosum, thrombocytosis, leukocytosis and dyspnoea as life-threatening and disabling events. Additional information is not expected.

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