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This is VAERS ID 619907

Case Details

VAERS ID: 619907 (history)  
Form: Version 1.0  
Gender: Female  
Location: Foreign  
Submitted: 2015-12-21
Entered: 2015-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Acne, Chest pain, Cognitive disorder, Decreased activity, Dizziness, Dyspnoea, Dysuria, Fatigue, Headache, Hypertonia, Hyperventilation, Hypoaesthesia, Menstrual disorder, Muscular weakness, Nausea, Orthostatic intolerance, Palpitations, Sleep disorder, Tilt table test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Parkinson-like events (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (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: At tilt table test at our department orthostatic intolerance is seen- but the patient does not fulfill the diagnostic criteria for POTS.
CDC Split Type: WAES1512DNK010259

Write-up: Information has been received from Sanofi Pasteur MSD (SPM) (MFR control number DK-1577272925-2015001034) on 18-DEC-2015. Case received from a physician via HA on 15-Dec-2015 under the reference number DK-DKMA-WBS-0002028 and DK-DKMA-ADR 23274783. A 16-year-old female patient adolescent patient received GARDASIL (batch number unknown) via intramuscular route on an unknown date. The patient experience Tiredness in FEB-2014, Headache on an unknown date, Chest pain (non-cardiac) on an unknown date, numbness in arms on an unknown date, Dizziness on an unknown date, Palpitation on an unknown date, Nausea on an unknown date, Abdominal pain on an unknown date, Acne on an unknown, Sleep disorder on an unknown date, Voiding difficulty on an unknown date, Cognitive disturbance on an unknown date, Muscle hyper excitability on an unknown date, Muscle weak lower limb on an unknown date, Hyperventilation on an unknown date, Dyspnea on an unknown date, Menstrual disorder on an unknown date, ortostatic tolerance on an unknown date and significant fall in activity level on an unknown date. The reporter does not have the patient''s vaccination dates, therefore it is not possibly certain to relate to a temporal relationship between the vaccine and symptom debut. The patient describes that the first symptom was increased tiredness and started in Feb-2014. Subsequently, the other reported adverse reaction develop. Significant fall in activity level and sick leave from work/education. At tilt table test at the reporter''s department orthostatic intolerance is seen - but the patient does not fulfill the diagnostic criteria for POTS. Unknown whether there are other vaccines or medications. The patient''s outcome was reported as Not Recovered/Not Resolved.

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