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This is VAERS ID 619025

Case Details

VAERS ID: 619025 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Foreign  
   Days after vaccination:0
Submitted: 2015-11-23
   Days after onset:2580
Entered: 2015-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Arthralgia, Constipation, Cyanosis, Dizziness, Dyspepsia, Ear pain, Fatigue, Gastrooesophageal reflux disease, Grip strength decreased, Headache, Hypersomnia, Increased tendency to bruise, Loss of personal independence in daily activities, Muscular weakness, Neuralgia, Oral mucosal blistering, Pain in extremity, Peripheral coldness, Pollakiuria, Sensory disturbance, Skin discolouration, Vision blurred, Weight bearing difficulty, Wheelchair user
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Immunisation
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1511DNK010750

Write-up: Information has been received from Sanofi Pasteur MSD (SPMSD) Case Report N. DK-1577272925-E2015-13059) on 18-NOV-2015. Case received from Patient Insurance Company (PIC) via Health Authorities on 16-Nov-2015 under the reference number DK-DKMA-ADR 23233468. The case is not medically confirmed. The primary reporter was a lawyer. A 13-year-old female patient had received three doses of GARDASIL (batch numbers not reported) via unspecified route of administration in unspecified site of administration on 30-Oct-2008, not reported date, and on 06-May-2009. On 30-Oct-2008, she developed headache, tiredness rapid exhaustion becomes markedly tired at small exertions, dizziness, feels that the eyes are blurry and vision becomes unclear, sleeps a lot, develops often blister in the mouth, acid reflux heartburn, tendency to constipation, develops pain in the ears, pain in both lower arms and hands, weakness in both lower arms and hands cannot support her own bodyweight at hips knee and ankles drops things from the hands, hands arms and fingers buzz, blue discoloration of nails, cold hands and feet, bruises easily, feels need to urinate often, severe neurogenic pain in lower legs and feet, and blue mottling patches/discoloration in the skin. On unspecified day in Nov-2008, she developed joint pain. On not reported date, she developed sits in wheelchair cannot manage much so her day is lying in bed, sofa and on toilet and go to physiotherapy. The HA received the case from the Patient Insurance Company (PIC) in the form of the patient''s claim. PIC has not yet made a decision in the matter. The patient has been on sick leave since 22-May-2014. Through the municipality, she has received a rehabilitation progression that lasts until Sep-2020. The case is serious due to seriousness criteria hospitalization and disability. No other medications. No information on medical history provided. At the time of reporting, the outcome was unknown for the reaction joint pain. The patient had not recovered from the other reactions.

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