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This is VAERS ID 630242

Case Details

VAERS ID: 630242 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Unknown  
   Days after vaccination:0
Submitted: 2016-04-04
   Days after onset:278
Entered: 2016-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Aphasia, Noninfective encephalitis, Optic neuritis, Seizure, Visual impairment
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (narrow), Demyelination (narrow), Lens disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Ocular infections (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1603USA014305

Write-up: This spontaneous report as received from a pharmacist (patient''s father) via company field representative refers to a 12 years old female patient. The patient''s medical history and concurrent conditions were none. On an unspecified date in July-2015 the patient had received her second dose of GARDASIL, lot # and expiry date was not reported. The patient had received unspecified concomitant medications. On an unspecified date in July-2015, the patient experienced visual disturbances (disability) and optic neuritis (disability). Therapy with GARDASIL was discontinued on an unspecified date in July-2015. Later in December-2015, she had chronic seizures (disability). Recently, on an unspecified date, she was diagnosed with inflammation of the left hemisphere of her brain (disability) and she could not speak (disability). The GARDASIL was not reintroduced. The outcome of the events were reported as not recovered. Upon internal review the events cannot speak, chronic seizures and inflammation of the left hemisphere of her brain were considered to be medically significant. Additional information has been requested.

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