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This is VAERS ID 619656

Case Details

VAERS ID: 619656 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: Foreign  
Vaccinated:2011-04-14
Onset:2011-05-01
   Days after vaccination:17
Submitted: 2015-12-16
   Days after onset:1690
Entered: 2015-12-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Blood test, Cat scratch disease, Headache, Lymphadenectomy, Lymphadenopathy, Nuclear magnetic resonance imaging abnormal, Pain, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Immunisation
Preexisting Conditions: 2012, Cat scratch disease, diagnosed with cat scratch diseases the year after vaccination
Allergies:
Diagnostic Lab Data: MRI nothing abnormal, appropriate blood test
CDC Split Type: WAES1512DNK008003

Write-up: Information has been received from Sanofi Pasteur MSD (SPM) (manufacturer control # DK-1577272925-2015000668) on 14-DEC-2015. Case received from a physician on 09-Dec-2015 under the CA report reference number DK-DKMA-WBS-0001954. A 12-year-old female adolescent patient received GARDASIL (batch number unknown, Dose 1) via intramuscular route on 14-Apr-2011, GARDASIL (batch number unknown, Dose 2) via intramuscular route on 15-Jun-2011, GARDASIL (batch number NL35410, lot # NK10770, expiration date 31-JAN-2012, Dose 3) via intramuscular route on 19-Oct-2011. Other medication: no. Magnetic resonance imaging (MRI) nothing abnormal, appropriate blood test. The patient experienced pain in body in MAY-2011, swollen lymph node in groin after vaccination in MAY-2011, headache in 2013 and intermittent swelling in leg after removing lymph node on an unknown date. The outcome of pain in body, intermittent swelling in leg after removing lymph node on an unknown date. The main problem since autumn 2013 is the headache. The outcome of pain in body, intermittent swelling in leg after removing lymph and headache was not resolved. The outcome of swollen lymph node in groin after vaccination was unknown. The agency considered the events as disability/incapacitating. She was diagnosed with Cat scratch disease in 2012, coded by Health Authority (HA) as medical history/concurrent disease.


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