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This is VAERS ID 274612

Case Details

VAERS ID: 274612 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: Unknown  
   Days after vaccination:0
Submitted: 2007-03-22
   Days after onset:79
Entered: 2007-03-23
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 - / -

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Ovarian cyst, Ovarian cyst ruptured, Ultrasound scan, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: ultrasound 01/??/07 - results not reported
CDC Split Type: WAES0703USA02141

Write-up: Information has been received from an office receptionist concerning a 12 year old female who in January 2007 was vaccinated with the first dose of Gardasil. Concomitant mediation was not reported. In January 2007, the developed an ovarian cyst that ruptured 10 days after receiving the first dose of Gardasil. Initially, the patient started vomiting for a few days and then there was significant abdominal pain. The patient was examined and diagnosed with ruptured ovarian cyst. The patient''s ovarian cyst and ruptured ovarian cyst persisted and were considered to be disabling. Additional information has been requested.

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