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This is VAERS ID 619802

Case Details

VAERS ID: 619802 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: Foreign  
   Days after vaccination:0
Submitted: 2015-12-18
   Days after onset:2299
Entered: 2015-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Acne, Angiopathy, Cognitive disorder, Condition aggravated, Dizziness, Fatigue, Headache, Hyperacusis, Hypertension, Laboratory test normal, Muscular weakness, Nausea, Peripheral coldness
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Hearing impairment (narrow), Vestibular disorders (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: Immunisation; Headache, already had headaches after prev. concussion
Preexisting Conditions: Concussion
Diagnostic Lab Data: Laboratory test, she dose not fulfill the criteria for postural orth
CDC Split Type: WAES1512DNK009441

Write-up: Information has been received from Sanofi Pasteur MSD (SPM) (manufacturer control # 2015001032) on 17-DEC-2015. Case received from a physician via health authority on 15-DEC-2015 under reference number DK-DKMA-WBS-0002035. A 14-year-old female adolescent patient received GARDASIL, (batch number unknown, Dose 1) via intramuscular route in Mar-2009, GARDASIL, (batch number unknown, Dose 2) via intramuscular route in May-2009, GARDASIL, (batch number unknown, Dose 3) via intramuscular route in Sep-2009. The patient experienced Headache (except migraine) aggravated in SEP-2009, Vascular abnormalities on an unknown date, Dizziness on an unknown date, Nausea on an unknown date, Abdominal pain on an unknown date, Acne on an unknown date, Fatigue on an unknown date, Cognitive disorder on an unknown date, Limb weakness on an unknown date, Sound sensitivity on an unknown date and cold hands and feets on an unknown date. Patient reports that she first developed aggravated headache (already had headaches after prev. concussion), thereafter she developed cold hands and feet. The departments investigations shows that she does not fulfill the diagnostic criteria for POTS., but she has a significant initial hypertension. Other medicines or vaccines: unknown. The patient had a medical history of: Headache -Concussion. The patient''s outcome was reported as Not Recovered/Not Resolved.

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