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This is VAERS ID 619870

Case Details

VAERS ID: 619870 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
Vaccinated:2013-12-11
Onset:2014-01-01
   Days after vaccination:21
Submitted: 2015-12-22
   Days after onset:720
Entered: 2015-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Cognitive disorder, Dizziness, Dry mouth, Dyskinesia, Dyspnoea, Dysuria, General physical health deterioration, Headache, Influenza like illness, Muscular weakness, Nausea, Palpitations, Photophobia, Sensory disturbance, Skin disorder, Sleep disorder, Syncope, Tilt table test normal, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dyskinesia (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (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: HPV immunisation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Tilt table test at the reporter''s department showed that the patient does not fulfill the diagnostic criteria for POTS
CDC Split Type: WAES1512DNK010822

Write-up: Information has been received form SPMSD (manufacturer control # DK-1577272925-2015001266) on 21-DEC-2015. Case received from a physician via HA on 18-Dec-2015 under reference number DK-DKMA-ADR 23278859 and DK-DKMA-WBS-0002059. A 12-year-old female adolescent patient received GARDASIL, (batch number unknown, Dose 1) via intramuscular route on 11-Dec-2013, GARDASIL, (batch number unknown, Dose 2) via intramuscular route on 17-Feb-2014, GARDASIL, (batch number unknown, Dose 3) via intramuscular route on 17-Jun-2014. The patient experienced Syncope in JAN-2014, Headache in JAN-2014, Dizziness in JAN-2014, Nausea on an unknown date, Palpitations on an unknown date, Voiding dysfunction on an unknown date, Skin problems on an unknown date, Dyspnoea on an unknown date, Sleep disorder on an unknown date, Cognitive dysfunction on an unknown date, Involuntary muscle movement on a unknown date, Limb weakness on an unknown date, Flu like symptoms on an unknown date, Dry mouth on an unknown date, Light sensitivity on an unknown date, Blurred vision on an unknown date, Sensory disturbance on an unknown date and Reduced general condition on an unknown date. Between 1st and 2nd vaccine - around Jan-2014 the patient experienced syncope. Also experienced headache and dizziness. Subsequently, the other reported symptoms developed. The patient described reduced general condition and large sick leave from 6th grade. Had to stop choir, as she could not breath. Unknown whether there were other vaccines or medications. Tilt table test at the reporter''s department showed that the patient does not fulfill the diagnostic criteria for POTS. At the time of reporting, the outcome was unknown for syncope. The patient was recovering/resolving from Voiding dysfunction and involuntary muscle movement. The patient had not recovered from the other reactions.


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