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This is VAERS ID 620102

Case Details

VAERS ID: 620102 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
   Days after vaccination:255
Submitted: 2015-12-23
   Days after onset:843
Entered: 2015-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H019870 / 3 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Arthralgia, Dizziness, Dyspnoea, Exercise tolerance decreased, Fatigue, Headache, Insomnia, Nausea, Palpitations, Presyncope, Tic
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dyskinesia (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (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: Human papilloma virus immunisation
Preexisting Conditions:
Diagnostic Lab Data: Examinations/laboratory test: unknown
CDC Split Type: WAES1512DNK010942

Write-up: Information has been received from Sanofi Pasteur MSD (SPM) (MFR# DK-1577272925-2015001183) on 21-DEC-2015. Case received from a physician via CA on 17-Dec-2015. A 12-year-old female patient adolescent patient received GARDASIL (lot/batch number unknown) via intramuscular route on 06-Jun-2012. Other suspect products included: GARDASIL (lot/batch number unknown, Dose 2) administered via intramuscular route on an unknown date. GARDASIL (lot/batch number unknown, Dose 3) administered via intramuscular route on 20-Dec-2012. The patient experienced Fatigue in SEP-2013, Headache in 2013, Nausea in 2013, Joint pain generalized in 2013, Near syncope in 2013, Dizziness in 2013, Palpitations in 2013, Abdominal pain generalized in 2013, Dyspnea in 2013, Sleep difficult in 2013, Tic in 2013 and Former elite gymnast, significantly decreased functioning in 2013. In two years the patient had recurring periods of dizziness and other adverse reactions reported. Onset of symptoms about 2 months after the third vaccination. Former elite gymnast, significantly decreased functioning. Other vaccines/medicines: unknown.

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