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This is VAERS ID 620107

History of Changes from the VAERS Wayback Machine

First Appeared on 5/14/2017

620107
VAERS Form:
Age:13.0
Gender:Female
Location:Foreign
Vaccinated:2010-12-13
Onset:0000-00-00
Submitted:2015-12-23
Entered:2015-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Dizziness, Presyncope, Exercise tolerance decreased, 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: HPV immunisation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: A tilt table test at the department (unknown date): showed orthostatic intolerance, but the patient does not fulfill the diagnostic criteria for POTS
CDC 'Split Type': WAES1512DNK010892

Write-up:Information has been received from Sanofi Pasteur MSD (manufacturer control number # 2015001188) as part of business agreement on 21-DEC-2015. Case received from a physician on 17-DEC-2015. A 13-year-old female adolescent patient received GARDASIL, (batch number unknown) via intramuscular route on 14-Apr-2010. Other suspect products included: Gardasil, (batch number unknown, Dose 2) administered via intramuscular route on 16-Jun-2010 -GARDASIL, (batch number unknown , Dose 3) administered via intramuscular route on 13-Dec-2010. The patient experienced Near syncope in DEC-2010, Dizziness in DEC-2010 and Exercise capacity decreased on an unknown date. Additional investigations included Tilt Table Test orthostatic intolerance n/a on an unknown date.Other HA comment: A tilt table test at the department showed orthostatic intolerance, but the patient does not fulfill the diagnostic criteria for POTS. Other medicines/and vaccines: unknown. 6 months after dose 2 of GARDASIL the patient attends a basketball tournament and get near syncope, then experience it several times with dizziness. Physical activity significantly reduced now.


Changed on 9/14/2017

620107 Before After
VAERS Form:(blank) 1
Age:13.0
Gender:Female
Location:Foreign
Vaccinated:2010-12-13
Onset:0000-00-00
Submitted:2015-12-23
Entered:2015-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 3 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Dizziness, Presyncope, Exercise tolerance decreased, 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: HPV immunisation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: A tilt table test at the department (unknown date): showed orthostatic intolerance, but the patient does not fulfill the diagnostic criteria for POTS
CDC 'Split Type': WAES1512DNK010892

Write-up:Information has been received from Sanofi Pasteur MSD (manufacturer control number # 2015001188) as part of business agreement on 21-DEC-2015. Case received from a physician on 17-DEC-2015. A 13-year-old female adolescent patient received GARDASIL, (batch number unknown) via intramuscular route on 14-Apr-2010. Other suspect products included: Gardasil, (batch number unknown, Dose 2) administered via intramuscular route on 16-Jun-2010 -GARDASIL, (batch number unknown , Dose 3) administered via intramuscular route on 13-Dec-2010. The patient experienced Near syncope in DEC-2010, Dizziness in DEC-2010 and Exercise capacity decreased on an unknown date. Additional investigations included Tilt Table Test orthostatic intolerance n/a on an unknown date.Other HA comment: A tilt table test at the department showed orthostatic intolerance, but the patient does not fulfill the diagnostic criteria for POTS. Other medicines/and vaccines: unknown. 6 months after dose 2 of GARDASIL the patient attends a basketball tournament and get near syncope, then experience it several times with dizziness. Physical activity significantly reduced now.


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