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This is VAERS ID 278788

Case Details

VAERS ID: 278788 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: Pennsylvania  
   Days after vaccination:5
Submitted: 2007-05-16
   Days after onset:40
Entered: 2007-05-17
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain upper, Blood bilirubin increased, Dysstasia, Full blood count, Hypoventilation
SMQs:, Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (narrow), Acute central respiratory depression (narrow), Biliary system related investigations, signs and symptoms (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Hypersensitivity
Preexisting Conditions:
Diagnostic Lab Data: complete blood cell 04/06?/07 - results not reported, total serum bilirubin 04/06?/07 - bilirubin was elevated
CDC Split Type: WAES0705USA02024

Write-up: Information has been received from a mother concerning her 12 year old daughter with hypersensitivity to red dye who in February 2007, was vaccinated with a first dose of Gardasil. In April 2007, the patient was vaccinated with her second dose of Gardasil there were no concomitant medications. On approximately 06-APR-2007 the patient experienced stomach pain, difficulty standing, and shallow breathing. The patient went to the emergency room where laboratory data revealed bilirubin was elevated. At the time of the report, the patient was recovering from the stomach pain, difficulty standing, shallow breathing, and elevated bilirubin. The consumer considered stomach pain, difficulty standing, shallow breathing, and elevated bilirubin to be disabling. Additional information has been requested.

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