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This is VAERS ID 620173

Case Details

VAERS ID: 620173 (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 pain, Arthralgia, Cognitive disorder, Constipation, Diarrhoea, Dizziness, Dyspnoea, Dysuria, Fatigue, Headache, Hyperventilation, Loss of personal independence in daily activities, Menorrhagia, Muscle spasms, Pain in extremity, Presyncope, Stress, Temperature regulation disorder, Tilt table test normal, Vision blurred
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (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? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Human papilloma virus immunisation
Preexisting Conditions:
Diagnostic Lab Data: A tilt table test showed normal condition.
CDC Split Type: WAES1512DNK011672

Write-up: Information has been received from Sanofi Pasteur MSD (MFR Control number DK-1577272925-2015001199) on 22-DEC-2015. Case received from a physician on 17-DEC-2015. A female adolescent patient of unknown age received GARDASIL, batch number unknown, Dose 1 via intramuscular route on 20-JAN-2009. Other suspect products included GARDASIL, batch/lot number unknown, Dose 2 administered via intramuscular route on 24-MAR-2009. The patient experienced Headache on an unknown date, Knee pain on an unknown date, Pain feet on an unknown date, Dizziness on an unknown date, Near syncope on an unknown date, Abdominal pain on an unknown date, Abdominal cramp on an unknown date, Obstipation on an unknown date, Diarrhea on an unknown date, Voiding difficulty on an unknown date, Dyspnoea on an unknown date, Menses regular with excessive bleeding on an unknown date, Hyperventilation on an unknown date, Fatigue / tired on an unknown date, Cognitive disturbance on an unknown date, Cramps on an unknown date, Stress in 2014, Temperature regulation disorder on an unknown date and Blurred vision on an unknown date. No other vaccines or medicines: unknown. Patient received two doses vaccine in the beginning of 2009, at 14/15-year-old. In ninth grade, patient experienced symptoms such as dizziness, sore knees, severe headache and was very tired. Subsequently, other reported symptoms develops. A tilt table test at the department show normal. Patient describes that she has been forced to abandon her education program. Has social assistance. Stress for a long period in 2014.

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