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This is VAERS ID 620408

History of Changes from the VAERS Wayback Machine

First Appeared on 5/14/2017

620408
VAERS Form:
Age:13.0
Gender:Female
Location:Foreign
Vaccinated:2011-04-05
Onset:0000-00-00
Submitted:2015-12-30
Entered:2015-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. NM31130 / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Systemic lupus erythematosus

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1512IRL013530

Write-up:Information has been received from Sanofi Pasteur MSD (reference No. IE-1577272925-2015001488) as a part of a business agreement on 28-DEC-2015. This case was received from the RA health authority on 23-DEC-2015 with reference number IE-HPRA-2015-025495. Initial report was received by the RA on 11/Dec/2015 from a member of the public which concerns a 13 year old Female patient who was diagnosed with Systemic lupus erythematosus following vaccination with GARDASIL. Concomitant medications: None. Medical history/concurrent conditions: None. The patient was vaccinated with 3 doses of GARDASIL at a dose of 0.5 ml via IV route between 13/Sep/2010 and 05/Apr/2011. Only one batch/lot number was provided - NM31130 (expiration date was not reported). 7 months post last dose, in Sep/2011, the patient was diagnosed with lupus (SLE). Corrective treatment: Prednisolone, azathioprine and PLAQUENIL. At the time of reporting the patient''s symptoms were ongoing. The patient outcome is not recovered/not resolved.


Changed on 9/14/2017

620408 Before After
VAERS Form:(blank) 1
Age:13.0
Gender:Female
Location:Foreign
Vaccinated:2011-04-05
Onset:0000-00-00
Submitted:2015-12-30
Entered:2015-12-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. NM31130 / 2 3 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Systemic lupus erythematosus

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1512IRL013530

Write-up:Information has been received from Sanofi Pasteur MSD (reference No. IE-1577272925-2015001488) as a part of a business agreement on 28-DEC-2015. This case was received from the RA health authority on 23-DEC-2015 with reference number IE-HPRA-2015-025495. Initial report was received by the RA on 11/Dec/2015 from a member of the public which concerns a 13 year old Female patient who was diagnosed with Systemic lupus erythematosus following vaccination with GARDASIL. Concomitant medications: None. Medical history/concurrent conditions: None. The patient was vaccinated with 3 doses of GARDASIL at a dose of 0.5 ml via IV route between 13/Sep/2010 and 05/Apr/2011. Only one batch/lot number was provided - NM31130 (expiration date was not reported). 7 months post last dose, in Sep/2011, the patient was diagnosed with lupus (SLE). Corrective treatment: Prednisolone, azathioprine and PLAQUENIL. At the time of reporting the patient''s symptoms were ongoing. The patient outcome is not recovered/not resolved.


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