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This is VAERS ID 644093

Case Details

VAERS ID: 644093 (history)  
Form: Version 1.0  
Gender: Unknown  
Location: Foreign  
Submitted: 2016-07-15
Entered: 2016-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Anaphylactic reaction, Disability, Mental disorder
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Dementia (broad), Hypersensitivity (narrow)

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:
Diagnostic Lab Data:
CDC Split Type: WAES1607VNM006550

Write-up: This solicited information has been received from an unknown source via the Company regarding unspecified number of patients of unknown demographics enrolled in a study. The patients'' concurrent condition, medical history and concomitant medications were not reported. On an unknown date, the patients were vaccinated with GARDASIL. There was over-immunization (also reported as disorderly immunization) anaphylaxis and mental (details unspecified) with GARDASIL vaccine that led to permanent or temporary disability of these patients. The outcome of the events were unknown at the time of this report. The causality assessment of the events were not provided. This is one of several reports received from the same reporter. Additional information is not expected as the reporter did not wish to be contacted.

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