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This is VAERS ID 646712

Case Details

VAERS ID: 646712 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Foreign  
Vaccinated:2010-10-01
Onset:2010-10-01
   Days after vaccination:0
Submitted: 2016-08-05
   Days after onset:2135
Entered: 2016-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Coxsackie viral infection, Herpes virus infection, Lyme disease
SMQs:

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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1608IRL003060

Write-up: Information has been received from Sanofi Pasteur MSD (SPM) on 04-AUG-2016. This case was received from RA (Ref no. IE-HPRA-2016-027321) on 02-AUG-2016. Initial case was received from a consumer/other non-health professional which concerns a 13-year-old female adolescent patient received GARDASIL, (batch number unknown), dose 1 (route of administration: intramuscular) on 01-OCT-2010, GARDASIL, (batch number unknown), dose 2 (route of administration: intramuscular) on 01-OCT-2011. Concomitant medications: None. Medical history/concurrent conditions: None reported. The patient experienced Chronic Lyme''s Disease, Active Coxsackie Virus and Active Herpes Virus Type 1 on 01-OCT-2010. The reporter added that the patient cannot leave bed for days and can''t live life. Corrective treatment: None. The reporter added that the patient is struggling from day to day. The patient''s outcome was reported as Not Recovered/Not Resolved. The reporter assessed the causal relationship: between Lyme disease, Coxsackie viral infection, Herpes simplex type 1 and GARDASIL as Unknown.


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