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This is VAERS ID 629523

Case Details

VAERS ID: 629523 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Foreign  
   Days after vaccination:7
Submitted: 2016-02-17
   Days after onset:1419
Entered: 2016-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Anxiety, Depression, Insomnia, Memory impairment, Panic attack
SMQs:, Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (narrow), Hypoglycaemia (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: Immunisation
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1602IRL007764

Write-up: Information has been received from Sanofi Pasteur MSD (SPM) (MFR#: IE-1577272925-2016001229) on 16-FEB-2016. This case was received from the HA on 12-Feb-2016 with reference number IE-HPRA-2016-025854. Initial report was received by the HA on 28/Jan/2016 from a member of the public which concerns a 13 year old female patient who experienced Depression, Panic attack, Insomnia, Anxiety disorder and memory impairment following vaccination with GARDASIL. Concomitant medications: None/ Medical history/concurrent conditions: None. The reporter indicated that the patient was 100% perfect. The patient was vaccinated with three doses of GARDASIL (batch numbers GOO5669, GOO5669 with expiration date: 31-JUL-2013, G0014502) in 30/Sep/2011 and 23/Mar/2012 (only two dates provided). Post vaccination, reported as 30/Mar/2012, the patient experienced depression, panic attacks, difficulty sleeping, anxious and memory lapse. Upon internal review the batch number GOO5669 was corrected to G005669. The events of Depression, Panic attack, Insomnia, Anxiety disorder and Memory impairment were considered to be serious as other medically significant condition and disabling/incapacitating. Corrective treatment: Medication, reflexology, counseling etc. At the time of reporting the patients'' symptoms were persisting. The patient outcome was reported as not recovered/not resolved.

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