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This is VAERS ID 682798

Case Details

VAERS ID: 682798 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
Submitted: 2017-02-16
Entered: 2017-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Unknown
Symptoms: Adverse reaction, General physical health deterioration

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:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: NO0095075131702NOR006007

Write-up: This spontaneous report as received from a patient''s mother via an another company refers to a female patient of unknown age. There was no information about the patient''s concurrent conditions, concomitant therapies or medical history provided. On an unknown date, the patient was vaccinated with the first dose of GARDASIL (dose, lot # and expiration date were not reported) for prophylaxis. In approximately 2014 (reported as approximately three years ago), the patient experienced a strong reaction with gradual deterioration after vaccination. It was reported that the girl was linked to bed at the time of the report. The outcome of the event was reported as not recovered. The relatedness between the event and GARDASIL was not reported. Upon internal review, the event of strong reaction with gradual deterioration was considered to be serious due to disability. Additional information has been requested.

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