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This is VAERS ID 619810

History of Changes from the VAERS Wayback Machine

First Appeared on 5/14/2017

619810
VAERS Form:
Age:15.0
Gender:Female
Location:Foreign
Vaccinated:2009-05-06
Onset:0000-00-00
Submitted:2015-12-22
Entered:2015-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Alopecia, Arthralgia, Disturbance in attention, Dyskinesia, Dyspnoea, Fatigue, Headache, Hypoaesthesia, Influenza, Myalgia, Psoriasis, Pyrexia, Sleep disorder, Vomiting, Impaired work ability, Temperature regulation disorder, Food intolerance, Postural orthostatic tachycardia syndrome, Orthostatic intolerance, Tilt table test positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Human papilloma virus immunisation
Preexisting Conditions:
Allergies:
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.


Changed on 9/14/2017

619810 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:Foreign
Vaccinated:2009-05-06
Onset:0000-00-00
Submitted:2015-12-22
Entered:2015-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 3 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Alopecia, Arthralgia, Disturbance in attention, Dyskinesia, Dyspnoea, Fatigue, Headache, Hypoaesthesia, Influenza, Myalgia, Psoriasis, Pyrexia, Sleep disorder, Vomiting, Impaired work ability, Temperature regulation disorder, Food intolerance, Postural orthostatic tachycardia syndrome, Orthostatic intolerance, Tilt table test positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Human papilloma virus immunisation
Preexisting Conditions:
Allergies:
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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