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This is VAERS ID 619493

Case Details

VAERS ID: 619493 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: Foreign  
   Days after vaccination:48
Submitted: 2015-12-14
   Days after onset:1504
Entered: 2015-12-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Dizziness, Fatigue, Headache, Pain, Vitamin D
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (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: Unknown
Preexisting Conditions:
Diagnostic Lab Data: Blood test fine, but D-vitamin 35, Now treated by own physician.
CDC Split Type: WAES1512DNK007194

Write-up: Information has been received from Sanofi Pasteur MSD (SPM) (MFR Control No: 2015000613) on 11-DEC-2015. Case received from a physician via the Agency on 08-Dec-2015, under the identification number DK-DKMA-WBS-0001935. A 11-year-old female child patient received GARDASIL, (batch number unknown, Dose 1) via intramuscular route on 10-Mar-2011, GARDASIL, (batch number unknown, Dose 2) via intramuscular route on 10-May-2011, GARDASIL, (batch number NL35410, lot number NK10770; expiration date unspecified, Dose 3) via intramuscular route on 14-Sep-2011. The patient experienced headache in NOV-2011, dizziness in NOV-2011, tired on an unknown date and pain in whole body on an unknown date. No other concomitant medicines or vaccines. After third dose headache and dizziness, later tired and pain in whole body. From being absence 3 days per week, now only one week per month. Blood test fine, but D-vitamin 35, Now treated by own physician. The patient''s outcome was reported as Recovering/Resolving.

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