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This is VAERS ID 522457

Case Details

VAERS ID: 522457 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: Unknown  
   Days after vaccination:53
Submitted: 2014-02-12
   Days after onset:108
Entered: 2014-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H020002 / 1 RA / IM

Administered by: Other       Purchased by: Other
Symptoms: Disability, Fatigue, Headache, Infectious mononucleosis

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: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1402USA004484

Write-up: This spontaneous report as received from a pharmacist via company representative refers to a 12 year old female patient (also reported as the pharmacist''s daughter). The patient did not have any pertinent medical history. On an unknown date in October 2013, the patient was vaccinated with a first dose of GARDASIL (route, dose, lot number and expiry date were not reported). On an unknown date in 2013, a couple of weeks later, after administration of GARDASIL the patient developed mononucleosis (disability) with a chronic headache (disability) and fatigue (disability). The pharmacist did not administer GARDASIL again and therapy with GARDASIL was discontinued. The outcome of the events mononucleosis, chronic headache and fatigue were unknown. The events mononucleosis, chronic headache and fatigue led to disability. Additional information has been requested.

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