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This is VAERS ID 541266

Case Details

VAERS ID: 541266 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Male  
Location: Foreign  
Vaccinated:2014-05-28
Onset:2014-05-28
   Days after vaccination:0
Submitted: 2014-08-27
   Days after onset:91
Entered: 2014-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J015338 / UNK UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Retching, Syncope, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1408AUS014760

Write-up: Information was obtained on a request by the company from the agency (agency # OPR341453) via a Public Case Detail concerning a 13 year old male patient. On 28-MAY-2014, the patient was vaccinated with GARDASIL lot # J015338, expiration date 11-APR-2016, 1 dose unspec as necessary, intramuscular. On 28-MAY-2014, the patient became unwell with dry reaching, then vomited and had a collapse. The outcome of dry reaching, vomited and had a collapse was reported as not yet recovered. The patient was on observation. The agency considered the events to be possibly related to GARDASIL. The agency considered the events as incapacitating/disabling. This was originally reported by a general practitioner. Additional information is not expected.


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