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This is VAERS ID 523248

Case Details

VAERS ID: 523248 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Foreign  
Vaccinated:2009-09-18
Onset:2010-03-01
   Days after vaccination:164
Submitted: 2014-02-21
   Days after onset:1453
Entered: 2014-02-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0773X / 3 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Cardiac stress test, Dyspnoea, Echocardiogram, Electrocardiogram, Palpitations, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
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: 05/29/2009, GARDASIL, immunisation; 03/12/2009, GARDASIL, Immunisation
Allergies:
Diagnostic Lab Data: Cardiac stress test, not provided; Echocardiogram, not provided; Electrocardiogram, not provided
CDC Split Type: WAES1402DNK009464

Write-up: Information has been received from SPSMD (manufacturer control # DK1577272925-E2014-01393) in 19-FEB-2014. Case was received from a health professional via the Health Authorities on 14-Feb-2014 under the references DK-DKMA-ADR 22409359 and DK-DKMA-EFO8127. Case is medically confirmed. Primary source was a physician. Case assessed as serious. A 15-year-old female patient (weight, height not reported) with no medical history reported received the third dose of GARDASIL (batch # NJ50800, lot #: 0773X, expired date: 16-JUN-2011) via intramuscular route on 18-Sep-2009. In March 2010, the patient developed tachycardia, breathlessness and palpitations. The patient was a soccer player who did not play in winter. Upon re-start of soccer in March 2010, she cold not play due to the adverse events. Cardiac investigations including medications were given. At the time of reporting, the patient had not recovered. Previous doses of GARDASIL were given via intramuscular route on 12-Mar-2009 (dose 1, batch#, NK36120, lot#: NJ33240, expired date: 30-SEP-2011) and on 29-May-2009 (dose 2, batch # NK05560, lot# 0773Z, expired date: 16-JUN-2011). Toleration was not reported.


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