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From the 11/26/2021 release of VAERS data:

This is VAERS ID 394405

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Case Details

VAERS ID: 394405 (history)  
Form: Version 1.0  
Age: 11.0  
Sex: Female  
Location: Florida  
   Days after vaccination:2
Submitted: 2010-07-26
   Days after onset:121
Entered: 2010-08-05
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Private
Symptoms: Arthralgia, Blood urine present, Diarrhoea, Flushing, Headache, Lethargy, Myalgia, Nausea, Pyrexia, Vision blurred, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Hypersensitivity (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant medications were unknown.
Current Illness:
Preexisting Conditions: No concomitant vaccinations. Relevant medical history was unknown. The subject had not experienced adverse events following previous vaccinations.
Diagnostic Lab Data: UNK
CDC Split Type: A0857520A

Write-up: This case was reported by a physician via sales representative and described the occurrence of muscle pain in a 12-year-old female subject who was vaccinated with CERVARIX (GlaxoSmithKline). On 25 March 2010 the subject received 1st dose of CERVARIX (.5 ml ,unknown, unknown arm). On 27 March 2010, 2 days after vaccination with CERVARIX, the subject experienced severe muscle pain, joint pain, vomiting, diarrhea, facial flushing, fever, nausea, blurred vision, lethargy, headache and blood in urine. On 10 April 2010, the muscle pain, joint pain, vomiting diarrhea, facial flushing, fever, nausea, blurred vision, lethargy, headache and blood in urine were resolved. Follow-up information received from healthcare professional (the subject''s mother) on 13 May 2010: CERVARIX was administered intramuscularly. The events resolved on 11 April 2010 (previously reported as 10 April 2010). The immunisation series with CERVARIX was discontinued.

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