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This is VAERS ID 619810

Case Details

VAERS ID: 619810 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Foreign  
Submitted: 2015-12-22
Entered: 2015-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Alopecia, Arthralgia, Disturbance in attention, Dyskinesia, Dyspnoea, Fatigue, Food intolerance, Headache, Hypoaesthesia, Impaired work ability, Influenza, Myalgia, Orthostatic intolerance, Postural orthostatic tachycardia syndrome, Psoriasis, Pyrexia, Sleep disorder, Temperature regulation disorder, Tilt table test positive, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (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: tilt table test, fulfills the criteria for POTS.
CDC Split Type: WAES1512DNK011065

Write-up: Information has been received from Sanofi Pasteur MSD (MFR number# DK-1577272925-2015001181) on 21-DEC-2015. Case received from a physician via health authority on 17-DEC-2015 DK-DKMA-WBS-00020883. A 15-year-old female adolescent patient received GARDASIL (batch number unknown, Dose 1) via intramuscular route on 29-OCT-2008, GARDASIL (batch number unknown, Dose 2) via intramuscular route on 07-JAN-2009, GARDASIL (batch number unknown, Dose 3) on 06-MAY-2009. The patient experienced Influenza recurrent in MAY-2009, fever on an unknown date, Fatigue on an unknown date, Headache on an unknown date, Hair loss on an unknown date, Dyspnoea on an unknown date, Sleeping disorder on an unknown date, Concentration ability impaired on an unknown date, Involuntary muscle movement on an unknown date, Numbness arm and legs on an unknown date, Food intolerance on an unknown date, Vomiting on an unknown date, Muscle pain on an unknown date, Joint pain on an unknown date, Psoriasis localized on an unknown date, Temperature regulation disorder in hands on an unknown date, Orthostatic intolerance on an unknown date and POTS on an unknown date. Additional investigations included Tilt Table Test pots on an unknown date. Onset after 3rd vaccination with recurrent influenza like symptoms. After that the other reactions. Reduced functional ability and a lot of absence from her training as office clerk - around 25%. The patient''s outcome was reported as Not Recovered/Not resolved.

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