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This is VAERS ID 503967

Case Details

VAERS ID: 503967 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
Vaccinated:2010-10-27
Onset:2010-11-01
   Days after vaccination:5
Submitted: 2013-09-25
   Days after onset:1059
Entered: 2013-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. NK10770 / 2 UN / SYR

Administered by: Other       Purchased by: Other
Symptoms: Activities of daily living impaired, Arthralgia, Bone pain, Groin pain, Laboratory test normal, Pain in extremity, Spinal pain
SMQs:, Dementia (broad), Osteonecrosis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

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: No other medications
Current Illness: Immunisation
Preexisting Conditions: GARDASIL, Immunisation, The patient''s medical history includes a vaccination with GARDASIL (dose 1, batch number NL30750, intramuscular route, site not reported) on 25-Aug-2010.
Allergies:
Diagnostic Lab Data: Unspecified laboratory tests have been performed on the patient on non-specified dates in 2013 with normal results.
CDC Split Type: WAES1309DNK010706

Write-up: Case received from health care professional via the Health Authorities on 16-Sep-2013 under the reference number 22241897 and EFO6856. Case medically confirmed. A 12 year old female patient (weight 55 kg and height 166 cm) had received an injection of GARDASIL (dose 2, batch number NL48770, lot number NK10770, exp 31-JAN-2012, intramuscular route, site not reported) on 27-Oct-2010 and concomitant with PRIORIX (other mfr, dose in series and batch number not reported, site and route not reported) on 25-Aug-2010 and later on 01-Nov-2010 she developed pain in groins, pain in the entire spine, pain in feet, pain in knees and pain in tibias. She had stopped taken part in sports activities as a result. The patient has also received GARDASIL vaccination (dose 3, batch number NL53870, intramuscular route, site not reported) on 02-Mar-2011. Unspecified laboratory tests have been performed on the patient on non-specified dates in 2013 with normal results. The patient has no other medications. The patient''s medical history includes a vaccination with GARDASIL (dose 1, batch number NL30750, intramuscular route, site not reported) on 25-Aug-2010. At the time of reporting, the outcome was not recovered.


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