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This is VAERS ID 619709

Case Details

VAERS ID: 619709 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
   Days after vaccination:61
Submitted: 2015-12-23
   Days after onset:1270
Entered: 2015-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Arthralgia, Orthostatic intolerance, Sleep disorder, Syncope, Tilt table test positive, Weight decreased, Weight increased
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Hypoglycaemia (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: Human papilloma virus immunisation
Preexisting Conditions:
Diagnostic Lab Data: Test examinations: During tilt table test orthostatic intolerance, but do not fulfill the criteria for Postural Orthostatic Tachycardia Syndrome (POTS).
CDC Split Type: WAES1512DNK010833

Write-up: Information has been received from Sanofi Pasteur MSD (SPM) (manufacturer control # DK-1577272925-2015001177) on 21-DEC-2015. Case received from a physician via health authority on 17-Dec-2015 under reference number DK-DKMA-WBS-0002100. A 12-year-old female adolescent patient received GARDASIL, batch number unknown via intramuscular route in May-2012. The patient experienced Joint pain in JUL-2012, Weight - gaining and then loosing in JUL-2012, Syncope on an unknown date, Abdominal pain on an unknown date and Sleep disorder on an unknown date. The patient had received previously two doses of GARDASIL (not reported dates). Onset after third dose (May 2012) approx. 2 months after administration. She describes that she had developed joint pain and that her weight is unstable she gain and she loose. After the other reactions. She does not remember the dates of the first 2 doses. Additional investigations included Tilt Table Test orthostatic intolerance on an unknown date. The patient''s outcome was reported as Not Recovered/Not Resolved.

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