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

This is VAERS ID 463963

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Case Details

VAERS ID: 463963 (history)  
Form: Version 1.0  
Age: 14.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2012-05-14
Onset:2012-05-14
   Days after vaccination:0
Submitted: 2012-09-04
   Days after onset:113
Entered: 2012-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS AHPVA113BB / 1 UN / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1295AA / UNK UN / UN

Administered by: Private       Purchased by: Private
Symptoms: Fatigue, Influenza like illness, Nausea, Oedema peripheral, Pain
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: The subject had no concomitant medications and no known allergies.
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: A0991830A

Write-up: This case was reported by a physician, via a sales representative, and described the occurrence of body pain in a 14-year-old female subject who was vaccinated with CERVARIX (GlaxoSmithKline), VARIVAX (non-gsk). On 14 May 2012 at 16:30 the subject received 1st dose of CERVARIX (.5 ml, unknown route) and on 14 May 2012 the subject received 2nd dose of VARIVAX (Non-GSK) (details unknown). On 14 May 2012, 1 hour after vaccination with CERVARIX and VARIVAX (Non-GSK), the subject experienced "overall" body pain, swelling arm, flu like symptoms, fatigue and nausea. The physician considered the events were disabling. The events lasted for 3 days. On 17 May 2012, the events were resolved. The subject consulted her healthcare provider. The vaccination course with CERVARIX was discontinued.


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