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This is VAERS ID 503967

Case Details

VAERS ID: 503967 (history)  
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 / 1 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
Died? No
Permanent Disability? Yes
Recovered? 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.
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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