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This is VAERS ID 555257

Case Details

VAERS ID: 555257 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Illinois  
Vaccinated:2012-01-03
Onset:2012-11-01
   Days after vaccination:303
Submitted: 2014-11-23
   Days after onset:752
Entered: 2014-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1359AA / 3 LA / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Anxiety, Concussion, Convulsion, Depression, Head injury, Neurological symptom, Panic attack, Postural orthostatic tachycardia syndrome, Syncope, Tachycardia, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (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: Swelling, Itching~Influenza (Seasonal) (no brand name)~1~14.92~Patient
Other Medications: None
Current Illness: No
Preexisting Conditions: Allergic to Eggs & Sulfa Meds
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Panic Attacks, Tachycardia. Syncope, Head Injuries, Concussions. Seizures. Convulsions. POTS (Postural Orthostatic Tachycardia Syndrome). Depression. Anxiety. Neurological Problems. Tremors.


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