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This is VAERS ID 620111

History of Changes from the VAERS Wayback Machine

First Appeared on 5/14/2017

620111
VAERS Form:
Age:15.0
Gender:Female
Location:Foreign
Vaccinated:0000-00-00
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: Abdominal distension, Constipation, Dizziness, Dry eye, Dry mouth, Hyperhidrosis, Myalgia, Nausea, Photophobia, Rash macular, Syncope, Cognitive disorder, Postural orthostatic tachycardia syndrome, 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)? Yes
ER or ED Visit? (V2.0) 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;
Allergies:
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.


Changed on 9/14/2017

620111 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:Foreign
Vaccinated:0000-00-00
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: Abdominal distension, Constipation, Dizziness, Dry eye, Dry mouth, Hyperhidrosis, Myalgia, Nausea, Photophobia, Rash macular, Syncope, Cognitive disorder, Postural orthostatic tachycardia syndrome, 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)? Yes
ER or ED Visit? (V2.0) 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;
Allergies:
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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