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This is VAERS ID 567659

Case Details

VAERS ID: 567659 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Male  
Location: New Jersey  
Vaccinated:2012-10-24
Onset:2013-02-09
   Days after vaccination:108
Submitted: 2015-03-02
   Days after onset:751
Entered: 2015-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H013831 / 2 RA / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Anal haemorrhage, Anal ulcer, Surgery
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal ulceration (narrow), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (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:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Patient has had four surgeries to close the ulcer located near his anus. All have been unsucessful.
CDC Split Type:

Write-up: Went to have bowel movement and started bleeding profusely from anal area. No prior symptoms.


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