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This is VAERS ID 567395

Case Details

VAERS ID: 567395 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Unknown  
Submitted: 2015-02-27
Entered: 2015-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Activities of daily living impaired, Condition aggravated, Irritable bowel syndrome
SMQs:, Dementia (broad), Noninfectious diarrhoea (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: Irritable bowel syndrome
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1502USA010611

Write-up: Information has been received from business manager via a company representative referring to a 12 year old female patient with pre-existing irritable bowel syndrome. On an unknown date the patient was vaccinated with a dose of GARDASIL (lot#, expiration date were unknown, one dose, once) intramuscularly. The patient has "exacerbated irritable bowel syndrome" after receiving the vaccine. The irritable bowel syndrome had worsened to the point that the patient was no longer able to go to school. The outcome of the event was reported as not recovered/not resolved. Upon internal review, the event of exacerbated irritable bowel syndrome was considered to be disabling. Additional information has been requested.

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