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This is VAERS ID 647241

Case Details

VAERS ID: 647241 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Male  
Location: Alabama  
Vaccinated:2012-02-21
Onset:2012-04-30
   Days after vaccination:69
Submitted: 2016-08-10
   Days after onset:1563
Entered: 2016-08-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1524AA / 1 LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Dementia, Generalised tonic-clonic seizure
SMQs:, Systemic lupus erythematosus (broad), Dementia (narrow), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Diagnosed with Gen Tonic/Clonic Epilepsy; Major Neurocog D/O with Exec Def
CDC Split Type:

Write-up: Generalized Tonic/Clonic Seizures. Major Neurocognitive D/O with executive Deficits. Takes medication daily.


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