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This is VAERS ID 646712

Case Details

VAERS ID: 646712 (history)  
Form: Version 1.0  
Gender: Female  
Location: Foreign  
   Days after vaccination:0
Submitted: 2016-08-05
   Days after onset:2135
Entered: 2016-08-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

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

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: 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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