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This is VAERS ID 513091

(NOTE: This result is from the 3/14/2014 version of the VAERS database)

Case Details

VAERS ID: 513091 (history)  
Form: Version .0  
Age: 13.0  
Gender: Female  
Location: Foreign  
Vaccinated:2008-11-04
Onset:2009-01-01
   Days after vaccination:58
Submitted: 2013-11-14
   Days after onset:1778
Entered: 2013-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Arthralgia, Blood test, Chest pain, Computerised tomogram head, Dyspnoea, Headache, Myalgia, Neurological examination, Nuclear magnetic resonance imaging brain
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1311DNK005011

Write-up: Case of adverse event received from health care professional via Health Authority on 05-Nov-2013 under the reference number DK-DKMA-ADR 22271499 and DK-DKMA-EFO7164. The primary reporter was a physician. Case is medically confirmed. A 13 year old female patient (weight: 58 kg; height: 166 cm), with no medical history reported, had received the primary dose of GARDASIL (batch number not reported) via intramuscular route of administration in not reported site of administration on 04-Nov-2008 and later on a non-specified date in Jan-2009 she developed air hunger, headache, chest pain, muscle pain and joint pain. Blood tests, pediatric examination for asthma, neurological examination, CT-scan and MRI-scan of the cerebrum was performed on a non-specified date (lab results not reported). The patient had no other medications. The patient received the second and third dose of GARDASIL (batch number not reported) via intramuscular route of administration in not reported site of administration on 24-Mar-2009 and 04-Aug-2009 respectively. At the time of reporting, the outcome was recovering from all reported adverse events.


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http://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20140314&IDNUMBER=513091


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