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This is VAERS ID 640267

Case Details

VAERS ID: 640267 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: Unknown  
Vaccinated:2011-03-30
Onset:2011-03-30
   Days after vaccination:0
Submitted: 2016-06-21
   Days after onset:1910
Entered: 2016-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1437Z / 1 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain upper, Back pain, Chest pain, Chills, Confusional state, Cystitis, Dizziness, Fatigue, Headache, Hyperhidrosis, Hypoaesthesia, Insomnia, Mental disorder, Muscle spasms, Nausea, Night sweats, Palpitations, Paraesthesia, Personality change, Photophobia, Pruritus, Pyrexia, Vaccination complication, Vision blurred
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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: Unknown
Preexisting Conditions: 01/2011, Surgery, twisted and necrotic ovary; 01/2011, Ovarian necrosis, required surgery
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1606USA009195

Write-up: Information was received from a lawyer regarding a case in litigation regarding an 11 year old female with history of a twisted and necrotic ovary with surgery (January 2011). It was reported that the patient followed her physician''s advice and on 30-MAR-2011 was vaccinated with her first dose of GARDASIL, (Lot number 667866/1437Z, expiration 25-FEB-2013). On 08-AUG-2011, the patient was vaccinated with her second dose of GARDASIL, (Lot number 667194/1271Z expiration 11-DEC-2012). On 12-DEC-2011, the patient was vaccinated with her third dose of GARDASIL, (Lot number 670049/1261AA, expiration 11-NOV-2013). It was reported that on 30-MAR-2011, almost immediately after the first injection, the patient began to experience stomach pain, bloating, feeling full, nauseated and bladder infection-like symptoms. After the completion of the three vaccinations, the symptoms worsened, and she began to suffer additional symptoms of insomnia, night sweats, day sweats, and chills. On an unknown date, she developed headaches, fatigue, fever, light sensitivity, blurred vision, personality changes, back pain itchiness, dizziness, chest pains and racing heart, spasms in her limbs, tingling and numbness in the hand and feet, confusion, and other mental abnormalities, all of which were reported to be caused by GARDASIL. The patient was told for over three years by her physician that her symptoms she experienced were post-operative symptoms. The patient''s symptoms worsened and medical advice from another physician on 20-NOV-2014, reported that the patient "is vaccine injured". The patient''s mother found medical literature regarding a finding of contamination of GARDASIL in nine different countries, and unfortunately, one of the listed GARDASIL contaminated lots was GARDASIL Lot # 1437Z, which is the lot number of the patient''s first injection of GARDASIL on 30-MAR-2011. The patient''s conditions were reported directly and proximately caused by the GARDASIL and are permanent. The conditions the patient has experienced has continued for over five years and are presumed to be permanent. Stomach pain, bloating/feeling full, nauseated and bladder infection-like symptoms, insomnia, night sweats, day sweats, chills, headaches, fatigue, fever, light sensitivity, blurred vision, personality changes, back pain itchiness, dizziness, chest pain and racing heart, spasms in her limbs, tingling and numbness in the hand and feet, confusion, and other mental abnormalities are considered disabling. Upon internal review, mental abnormalities was determined to be important medical event. Additional information has been requested.


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