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This is VAERS ID 620111

Case Details

VAERS ID: 620111 (history)  
Form: Version 1.0  
Age: 15.0  
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 distension, Cognitive disorder, Constipation, Dizziness, Dry eye, Dry mouth, Hyperhidrosis, Myalgia, Nausea, Orthostatic intolerance, Photophobia, Postural orthostatic tachycardia syndrome, Rash macular, Syncope, Tilt table test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (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: Immunisation
Preexisting Conditions: Depressed mood; GARDASIL, dose 2; GARDASIL, dose 1;
Diagnostic Lab Data: Tilt table test (in 2011): possible explanation to syncopes. 2015, Tilt table test, POTS.
CDC Split Type: WAES1512DNK010940

Write-up: Information has been received from Sanofi Pasteur MSD (MFR Control Number 2015001186) on 21-DEC-2015, as a part of business agreement. Case received from a physician via HA on 17-DEC-2015 under the reference number DK-DKMA-WBS-0002079 and DK-DKMA-ADR 23277206. A 15-year-old female adolescent patient received GARDASIL via intramuscular route in 2008. The patient experienced Syncope in 2009, Muscle pain in 2009, Nausea in 2009, Dizziness on an unknown date, Orthostatic intolerance on an unknown date, Eyes dry on an unknown date, Dry mouth on an unknown date, Skin blotches on an unknown date, Sweating abnormal on an unknown date, Bloated feeling on an unknown date, Obstipation on an unknown date, Light sensitivity to eye on an unknown, Cognitive function abnormal on an unknown date and POTS on an unknown date. Symptom debut in 2009 with muscle pain and syncope, hospitalized at least 2 times for investigation without diagnosing. Tilt table test in 2011 show possible explanation of syncope. Significant disabling condition. The reporter does not have exact vaccination dates (possibly 2008). Tilt table test at the reporter''s department showed that the patient fulfills the diagnostic criteria for POTS. Unknown whether there were other medications and vaccines. The patient was admitted to hospital on an unspecified date. The patient had a medical history of Depressed mood. Additional investigations included: Tilt Table Test possible explanation to syncopes in 2011, Tilt Table Test POTS in 2015. At the time of reporting, the outcome was unknown for POTS. The patient had not recovered from the other reactions.

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