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This is VAERS ID 506357

Case Details

VAERS ID: 506357 (history)  
Form: Version 1.0  
Age: 20.0  
Sex: Female  
Location: Foreign  
Vaccinated:2012-09-15
Onset:2012-09-15
   Days after vaccination:0
Submitted: 2013-10-03
   Days after onset:383
Entered: 2013-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H007797 / 1 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Gait disturbance, Mental disorder, Muscle spasms, Pain, Sensory disturbance
SMQs:, Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Immunisation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1310DNK001354

Write-up: Case received from non-health professional via Health Authorities on 26-Sep-2013 under the reference numbers 22252694 and 13-6626 (patient insurance company). The primary reporter was a lawyer from patient insurance company. Case is not medically confirmed. A 20 year old female patient, developed on 15-Sep-2012 sensory disturbance, cramps, unsteady walking mode and pain in association with the cramps, after she had received primary injection of GARDASIL (batch and lot number H007797) via not reported route and in not reported site of administration on 15-Sep-2013. HA: Case received on 17-Sep-2013 from the patient insurance company J. no. 13-6626 in terms of the patient''s initial notification. Note that the patient insurance company has not taken a decision on the matter yet. Adverse reactions: Cramping and pain associated with the cramps, sensory disturbance in both legs and feet and unsteady walking mode. Description of the adverse reactions: The patient cannot run anymore and feel that the adverse reactions have had major psychological consequences. The patient is undiagnosed despite hospitalizations and various examinations. The patient has received medical treatment for the adverse reactions (she has not reported which). Physician''s vaccination service informs the on 26-Sep-2013 that first vaccination was given on 15-Sep-2012 has the batch number H007797 and second vaccination given on 10-Nov-2012 have the same batch number as the first vaccination i.e. H007797 and number H007797 and second vaccination given on 10-Nov-2012 have the same batch number as the first vaccination i.e. H007797 and the third vaccination given on the 12-Mar-2013 has the batch and lot number J000160, exp. 30-JUN-2015. No information on medical history reported. At the time of reporting, the outcome was not recovered.


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