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This is VAERS ID 630655

Case Details

VAERS ID: 630655 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: Foreign  
   Days after vaccination:5
Submitted: 2016-03-07
   Days after onset:2303
Entered: 2016-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Activities of daily living impaired, Amnesia, Craniocerebral injury, Dizziness, Dysarthria, Emotional distress, Haematoma, Headache, Impaired work ability, Nausea, Nervous system disorder, Pain, Seizure, Skin abrasion
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (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: WAES1603CAN002762

Write-up: Information has been received from a lawyer regarding a case in litigation concerning a 14 year old female patient, who on 11-NOV-2009 was vaccinated with her first dose of GARDASIL (dosage, lot number and route of administration not provided). On 16-NOV-2009, the patient experienced a seizure and was taken to the emergency department presenting with slurred speech, hematoma, nausea, and abrasions. On or about February or March 2010, the patient was administered a second dose of GARDASIL, and a third dose was administered in or about May 2010 (dosages, lot numbers and routes of administration not provided). The patient suffered further seizures on or about 29-JUL-2010 and 12-NOV-2012. As a result, the patient sustained serious personal injuries including, but not limited to: traumatic brain injury, neurological damage and disorder, memory loss, headaches, and lightheadedness (onset not provided), as well as seizures, slurred speech, hematoma, abrasions and nausea. As a result of the injuries suffered, the patient has experienced pain and suffering and loss of the amenities of life and has been forced to undergo and will continue in the future to require lengthy and painful therapy and treatments for her rehabilitation. As a further result of her injuries, the patient has suffered and will continue to suffer loss of income as a result of being restricted in her ability to work, and required ongoing care to assist with all activities of daily living. The outcome of the seizures, lightheadedness, headache, memory loss, neurological damage and disorder, traumatic brain injury, abrasions, nausea, hematoma and slurred speech is unknown. Upon internal review, seizures (16-NOV-2009, 29-JUL-2010 and 12-NOV-2012) were determined to be medically significant. Seizures, traumatic brain injury, neurological damage and disorder, slurred speech, hematoma, abrasions, memory loss, headaches, lightheadedness, and nausea were considered to be disabling. Additional information has been requested.

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