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This is VAERS ID 618592

History of Changes from the VAERS Wayback Machine

First Appeared on 6/14/2017

618592
VAERS Form:
Age:12.0
Gender:Female
Location:Foreign
Vaccinated:2010-02-24
Onset:2013-11-01
Submitted:2015-11-18
Entered:2015-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Blood glucose, Disturbance in attention, Dizziness, Fatigue, Haemoglobin, Headache, Memory impairment, White blood cell count, Neurological examination, Loss of personal independence in daily activities

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medication
Current Illness: Immunisation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: The patient has undergone general check up with test for leukocytes, haemoglobin, blood glucose and neurological examination (not further specified).
CDC 'Split Type': WAES1511DNK009345

Write-up:Information has been received from Sanofi Pasteur MSD (SPM) (manufacturer control # DK-1577272925-E2015-12968) on 17-NOV-2015. Case received from Health Care Professional via Health Authorities on 13-Nov-2015 under the reference number DK-DKMA-ADR 23227614 and DK-DKMA-WBS-0001664. The case is medically confirmed. The primary reporter was physician. A 16-year-old female patient had received three doses of GARDASIL, (lot/batch numbers not reported) via intramuscular route of administration in unspecified site of administration on 18-Aug-2009, 21-Oct-2009 and 24-Feb-2010, respectively. On 1-Nov-2013, she developed dizziness, tiredness, reduced concentration ability/inability to focus, and reduced memory. On an unspecified date, she developed headache, and previously very sports active with horseback riding and training and school, can now almost not manage anything, a lot less riding and sports. The patient does not participate in school education. The case is serious due to seriousness criterion disability. No other vaccines or medications were reported. The patient had undergone general check up with test for leukocytes, haemoglobin, blood glucose and neurological examination (not further specified). No information on medical history was provided. At the time of reporting, the patient had not recovered.


Changed on 9/14/2017

618592 Before After
VAERS Form:(blank) 1
Age:12.0
Gender:Female
Location:Foreign
Vaccinated:2010-02-24
Onset:2013-11-01
Submitted:2015-11-18
Entered:2015-11-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 3 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Blood glucose, Disturbance in attention, Dizziness, Fatigue, Haemoglobin, Headache, Memory impairment, White blood cell count, Neurological examination, Loss of personal independence in daily activities

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medication
Current Illness: Immunisation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: The patient has undergone general check up with test for leukocytes, haemoglobin, blood glucose and neurological examination (not further specified).
CDC 'Split Type': WAES1511DNK009345

Write-up:Information has been received from Sanofi Pasteur MSD (SPM) (manufacturer control # DK-1577272925-E2015-12968) on 17-NOV-2015. Case received from Health Care Professional via Health Authorities on 13-Nov-2015 under the reference number DK-DKMA-ADR 23227614 and DK-DKMA-WBS-0001664. The case is medically confirmed. The primary reporter was physician. A 16-year-old female patient had received three doses of GARDASIL, (lot/batch numbers not reported) via intramuscular route of administration in unspecified site of administration on 18-Aug-2009, 21-Oct-2009 and 24-Feb-2010, respectively. On 1-Nov-2013, she developed dizziness, tiredness, reduced concentration ability/inability to focus, and reduced memory. On an unspecified date, she developed headache, and previously very sports active with horseback riding and training and school, can now almost not manage anything, a lot less riding and sports. The patient does not participate in school education. The case is serious due to seriousness criterion disability. No other vaccines or medications were reported. The patient had undergone general check up with test for leukocytes, haemoglobin, blood glucose and neurological examination (not further specified). No information on medical history was provided. At the time of reporting, the patient had not recovered.


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