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This is VAERS ID 540015

Case Details

VAERS ID: 540015 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Male  
Location: New York  
   Days after vaccination:14
Submitted: 2014-08-15
   Days after onset:127
Entered: 2014-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Alopecia, Asthenia, Emotional distress, Fatigue, Skin papilloma
SMQs:, Guillain-Barre syndrome (broad), Depression (excl suicide and self injury) (broad)

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: WAES1408USA008872

Write-up: This spontaneous report was received from patient''s mother via company representative refers to a 11 year old male patient. Medical history was not reported. In September 2013 the patient was vaccinated with the first dose of GARDASIL the second dose was administered in November 2013 and the third dose was administered on 27-MAR-2014, the lot number, expiration date, strength and route were not reported for all of them. Concomitant therapy was not reported. The consumer informed that approximately on 10-APR-2014 (also reported as two weeks after the third dose) her son felt weak and fatigued and patches of his hair began to fall out. Also informed that she took her son to see a dermatologist who diagnosed her son with alopecia. A topical ointment was used on the patient''s scalp to prevent further hair loss, therefore the patient began receiving shots in his scalp. The consumer also stated that on approximately August 2014, her son just got three warts on his hand and he was still tired, which was causing him significant distress. The reporter considered that the events caused significant disability or incapacity to the patient. The outcome of the events was not recovered. Additional information is not expected because the reporter refuse the contact with the physician.

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