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This is VAERS ID 528673

Case Details

VAERS ID: 528673 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2014-04-17
Entered: 2014-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J007399 / UNK UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Malaise, Mydriasis, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Immunisation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1404GBR009756

Write-up: Information has been received from Sanofi Pasteur MSD (SPM) (Manufacturer control number E2014-03331) on 15-APR-2014. This case was received from health authority on 10-Apr-2014. GB-MHRA ADR 22488410. The case is medically confirmed. A 12 year old female patient, with no medical history reported, received an injection of GARDASIL (batch number and lot # J007399 and expiry date 29-FEB-2016) intramuscularly, dose in series and site of administration not reported, on an unreported date and on unreported dates after vaccination, the patient experienced huge pupils for over 24 hours, she felt very unwell for 48 hours and had vomited 3 times. At the time of reporting, the patient has recovered from all the adverse events. The regulatory authority considered that case serious due to the patient''s disability.


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