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This is VAERS ID 515090

Case Details

VAERS ID: 515090 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Foreign  
   Days after vaccination:7
Submitted: 2013-11-29
   Days after onset:611
Entered: 2013-11-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Investigation, Post viral fatigue syndrome, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (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: BOOSTRIX
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1311IRL011956

Write-up: Information has been received from SPMSD (IE-1577272925-E2013-09803) on 26-NOV-2013. This cases was received from health authority in a foreign country on 21-Nov-2013. IMB REF 2013-018774. The case is medically confirmed. A 13 year old female patient, received a third dose of GARDASIL (batch number not reported) by intramuscular route, site of administration not reported and an injection of BOOSTRIX (batch number AC37B062AQ) by intramuscular route, dose in series and site of administration not reported, on 21-MAR-2012. On 28-MAR-2012, several days after vaccination, the patient collapsed and was subsequently diagnosed with myalgic encephalomyelitis with severe symptoms. The patient attended hospital for ongoing management and has had extensive investigations (no results reported). The patient previously received a first dose of GARDASIL (batch number not reported), by intramuscular route, site of administration not reported, on 19-SEP-2011 and a second dose of GARDASIL (batch number not reported), by intramuscular route, site of administration not reported, on an unspecified date. At the time of reporting, the patient was not recovered. The IMB considered that case serious due to the patient''s disability and to be medically significant.

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