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This is VAERS ID 541270

Case Details

VAERS ID: 541270 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: New Jersey  
   Days after vaccination:122
Submitted: 2014-08-27
   Days after onset:87
Entered: 2014-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J006850 / 3 LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Abasia, Myositis, Parvovirus B19 test positive, Parvovirus infection
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: Parvovirus (2014): The patient tested positive.
CDC Split Type: WAES1408USA013940

Write-up: This spontaneous report as received from a physician via a company representative refers to a 15 year old female patient with no known allergies. No pertinent medical history was provided. On 10-JUL-2013, the patient was vaccinated with the first dose of GARDASIL inj (dose, route and lot number not provided). On 14-SEP-2013, the patient received the second dose of GARDASIL, and on 30-JAN-2014 the patient received the third dose of GARDASIL (doses, routes and lot numbers not provided). No co-suspect or concomitant therapies were provided. The physician reported that the patient was admitted to a hospital on 06-JUL-2014 for unspecified symptoms. The patient tested positive for parvovirus (date not provided, approximately in 2014). The patient was also diagnosed with mild myositis (date not provided, approximately in 2014). The physician stated that the patient was unable to walk at some point during her hospitalization as a result of the myositis which was a significant disability (date not provided, approximately in 2014). The patient was discharged from the hospital on an unspecified date (approximately in 2014). The patient also saw an unspecified Neurologist and Rheumatologist on unspecified dates. On an unspecified date, approximately in 2014, the patient was in recovery according to information received by the primary care physician from the neurologist. The reporting physician considered the events "The patient was also diagnosed with mild myositis" and "The patient was unable to walk at some point during her hospitalization" as disability events. Additional information is not expected because there was no consent to follow-up with the reporting physician.

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