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This is VAERS ID 619756

Case Details

VAERS ID: 619756 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
   Days after vaccination:0
Submitted: 2015-12-24
   Days after onset:2275
Entered: 2015-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Constipation, Fatigue, General physical health deterioration, Headache, Influenza, Loss of personal independence in daily activities, Orthostatic intolerance, Photophobia, Presyncope, Tilt table test positive, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Infective pneumonia (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? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Human papilloma virus immunisation
Preexisting Conditions:
Diagnostic Lab Data: Tilt table test at Syncope center, orthostatic intolerance is seen- but the patient does not fulfill the diagnostic criteria for POTS.
CDC Split Type: WAES1512DNK011936

Write-up: Information has been received from SPMSD (case report # DK-1577272925-2015001268) on 22-DEC-2015. Case received from a physician via HA on 18-Dec-2015 under the reference number DK-DKMA-WBS-0002049 and DK-DKMA-ADR 23278853. A 12-year-old female adolescent patient received GARDASIL batch/lot number and expiration date were unknown, Dose 1 via intramuscular route on 02-Apr-2009, GARDASIL, batch/lot number and expiration date were unknown, Dose 2 via intramuscular route on 08-Jun-2009, GARDASIL, batch/lot number and expiration date were unknown, Dose 3 via intramuscular route in Oct-2009. The patient experienced Influenza in OCT-2009, Abdominal cramp on an unknown date, Near syncope in 2010, Fatigue on an unknown date, Headache on an unknown date, Vomiting on an unknown date, Ortostic intolerance on an unknown date, Obstipation on an unknown date, Light sensitivity to eye on an unknown date, had to stop horse riding at high level as well education as fitness instructor on an unknown date and Significantly reduced general condition on an unknown date. Symptom debut after 3rd vaccine with recurrent influenza event, significantly reduced general condition. Previously, the patient engaged in riding and rode daily, had to stop riding at high level and education as fitness instructor. Tilt table test at hospital, orthostatic intolerance is seen - but the patient does not fulfill the criteria for POTS. Hospital use the following criteria to confirm the diagnosis POTS: Heart rate increases greater than or equal to 30 bpm from supine to standing (10 min) in the absence of orthostatic hypotension (decrease in BP greater than 20/10 mmHg). Symptoms worsen with standing and improved with recumbence. Symptoms last greater than or equal to 6 months. Absence of other overt cause of orthostatic symptoms or tachycardia (e.g., active bleeding, acute dehydration, medications). In addition, an additional criteria is used in patients between 12-19 year old: require a pulse increase greater than 40 bpm to confirm the diagnosis, based on that young people have a greater physiological pulse response upon standing up. This additional criterion is used to avoid false positives. Unknown whether there were other vaccines or medications. At the time of reporting, the patient was recovering/resolving from influenza and near syncope. The patient had recovered from vomiting on unknown date. The patient had not recovered from the other reactions.

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