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This is VAERS ID 524473

Case Details

VAERS ID: 524473 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Foreign  
   Days after vaccination:2
Submitted: 2014-03-04
   Days after onset:915
Entered: 2014-03-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Blood pressure decreased, Chest pain, Cytomegalovirus test positive, Discomfort, Dyspnoea, Epstein-Barr virus test positive, Headache, Heart rate increased, Muscle spasms, Palpitations, Pollakiuria, Postural orthostatic tachycardia syndrome, Roseolovirus test positive, Tilt table test positive
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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: Coeliac disease; Immunisation
Preexisting Conditions: Roseolovirus test, Positive; Cytomegalovirus test, Positive; Epstein-Barr virus test, Positive
Diagnostic Lab Data: Cytomegalovirus test, Positive; Epstein-Barr virus test, Positive; Roseolovirus test, Positive; Tilt table test, Significant increase in heart rate
CDC Split Type: WAES1402DNK013578

Write-up: Information has been received from SPMSD (reference number E2014-01700) on 27-FEB-2014. Case was received from a health care professional via the Health Authorities on 25-Feb-2014 under the references DK-DKMA-ADR 22430204 and DK-DKMA-EFO8281. Case is medically confirmed. Primary source was a physician. A 13-year-old female patient (weight 56 kg, height 177 cm) with a medical history of positive Epstein-Barr virus test, cytomegalovirus test and human Herpes virus 6 test as well as celiac disease received an injection of GARDASIL, (batch number NN02290, lot # NK44350, expiration date 31-MAY-2012) intramuscular route into not reported site of administration on 30-Aug-2011. On 01-Sep-2011, the patient developed postural orthostatic tachycardia syndrome. On an unspecified date, the patient also developed orthostatic discomfort, heart palpitation, shortness of breath on physical exertion, chest pain on physical exertion, headache, frequent urination and muscle cramps. Tilt table test showed significant increase of heart rate ($g40 bpm) and tendency to decrease in blood pressure. The patient was also investigated for infectious diseases revealing positive tests for EBV, CMV and HH6. It was unknown if other vaccines or medicines were given. At the time of reporting, the patient had not recovered.

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