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This is VAERS ID 620104

Case Details

VAERS ID: 620104 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: Foreign  
Vaccinated:2014-10-22
Onset:2014-11-01
   Days after vaccination:10
Submitted: 2015-12-23
   Days after onset:417
Entered: 2015-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Angiopathy, Cognitive disorder, Condition aggravated, Dizziness, Dyskinesia, Fatigue, General physical health deterioration, Headache, Influenza like illness, Menorrhagia, Muscular weakness, Myalgia, Nausea, Photophobia, Presyncope, Pyrexia, Tilt table test normal, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Dyskinesia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Human papilloma virus immunisation
Preexisting Conditions: Sleep disorder; Headache; M-M-RVAXPRO
Allergies:
Diagnostic Lab Data: Test examinations: Tilt table test, does not fulfill the diagnostic criteria for POTS
CDC Split Type: WAES1512DNK011076

Write-up: Information has been received from Sanofi Pasteur MSD (MFR Control number DK-1577272925-2015001264) on 21-DEC-2015. Case received from a physician via health authority on 18-Dec-2015 under reference number DK-DKMA-WBS-0002100. A 11-year-old female child patient received GARDASIL (batch/lot number unknown, Dose 1) via intramuscular route on 22-Oct-2014. Other suspect products included M-M-RVAXPRO, batch number unknown) administered via intramuscular route on 22-Oct-2014. The patient experienced Headache aggravated in NOV-2014, Flu like symptoms in NOV-2014, Excessiv menstrual bleeding in DEC-2014, Muscle pain on an unknown date, Subfebrilla on an unknown date, Near syncope on an unknown date, Dizziness on an unknown date, Nausea on an unknown date, Abdominal pain on an unknown date, Aggrevated sleep disorder on an unknown date, Fatigue extreme on an unknown date, Cognitive disorder on an unknown date, Involuntary muscle movement in legs and feet on an unknown date, Limb weakness on an unknown date, Light sensitivity to eyes on an unknown date, Vascular abnormalities on an unknown date, Blurred vision on an unknown date and reduced general function on an unknown date. After first dose, the patient experience influenza like symptoms and aggravation of headache. Approximately 60 days post vaccination she experience a excessive menstrual bleeding that required hospitalization. Did not get more doses. After the rest of the symptoms. The patient did not fulfill the diagnostic criteria for POTS with tilt table test. The patient describes reduced function and has a lot of sick leave from grade 6-7. Other medicines: Unknown. The patient was admitted to hospital on an unspecified date. The patient had a medical history of: Sleep disorder. Headache. The patient had received MMRVAXPRO. Additional investigations included Tilt Table Test not pots n/a on an unknown date. The patient''s outcome was reported as Not Recovered/Not Resolved. Headache aggravated, Flu like symptoms, Muscle pain, Near syncope, Dizziness, Nausea, Abnormal pain, Fatigue extreme, Blurred vision, Excessive menstrual bleeding, subfebrille, Aggravated sleep disorder, Cognitive disorder, Involuntary muscle movement in legs and feet, Limb weakness, Light sensitivity to eyes, vascular abnormalities.


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