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This is VAERS ID 596331

Case Details

VAERS ID: 596331 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2010-09-01
Submitted: 2015-09-14
   Days after onset:1839
Entered: 2015-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / SYR

Administered by: Other       Purchased by: Other
Symptoms: Activities of daily living impaired, Adverse event
SMQs:, Dementia (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: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1509USA006034

Write-up: This initial spontaneous report was received from the patient''s mother referring to her daughter; a female patient of unknown age. There was no pertinent medical history or drug allergies/drug reactions reported. On an unknown date, the patient was vaccinated with an unspecified dose of GARDASIL injection (strength, dose, route, lot # and expiration date were not provided). There was no concomitant medication described. The reporter stated that since on an unknown date in September 2010, her daughter had been "out of school" due to developed unspecified symptoms after receiving GARDASIL. At the time of the report, the outcome of adverse event was not recovered. The relatedness between the adverse event to GARDASIL was not reported. Upon internal review adverse event was considered as disabling. Additional information has been requested.


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