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This is VAERS ID 620109

Case Details

VAERS ID: 620109 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
Submitted: 2015-12-23
Entered: 2015-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Arthralgia, Cognitive disorder, Dizziness, Headache, Influenza, Malaise, Muscular weakness, Myalgia, Orthostatic intolerance, Palpitations, Photophobia, Presyncope, Syncope, Tilt table test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (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), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Infective pneumonia (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: HPV immunisation
Preexisting Conditions:
Diagnostic Lab Data: At tilt table test at the department, orthostatic intolerance is seen - but the patient does not fulfill the diagnostic criteria for POTS.
CDC Split Type: WAES1512DNK011086

Write-up: Information has been received from Sanofi Pasteur MSD (MFR Control number DK-1577272925-2015001278) on 21-DEC-2015. Case received from a physician via HA on 18-DEC-2015 under the reference number DK-DKMA-ADR 23278872 and DK-DKMA-WBS-0002108. A 12-year-old female adolescent patient received GARDASIL, (batch/lot number unknown, Dose 1) via intramuscular route on 07-JUN-2010, GARDASIL, (batch/lot number unknown, Dose 2) via intramuscular route on 13-AUG-2010, GARDASIL, (batch/lot number unknown, Dose 3) via intramuscular route on 24-MAR-2011. The patient experienced Abdominal pain in AUG-2010, Dizziness in JUN-2010, Headache on an unknown date, Muscle pain on an unknown date, Joint pain on an unknown date, Syncope in JUN-2011, Near syncope on an unknown date, Palpitation on an unknown date, Cognitive disorder on an unknown date, Muscle weakness on an unknown date, Influenza recurrent on an unknown date, Light sensitivity to eye on an unknown date, Malaise in JUN-2010 and Orthostatic intolerance on an unknown date. Symptom debut after 1st vaccination, where she becomes ill in the middle of a handball game, with malaise and dizziness and after the second vaccination she becomes hospitalized with severe abdominal pain, later the other reported symptoms develop. At tilt table test at the department, orthostatic intolerance is seen - but the patient does not fulfill the diagnostic criteria for POTS. Unknown whether there were other medications or vaccines. At the time of reporting, the patient had recovered from influenza recurrent (on not reported date), the outcome was unknown for the reactions syncope, muscle weakness, malaise and orthostatic intolerance. The patient had not recovered from the other reactions.

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