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This is VAERS ID 541266

Case Details

VAERS ID: 541266 (history)  
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 / - 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
Died? No
Permanent Disability? Yes
Recovered? No
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: 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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