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This is VAERS ID 620207

Case Details

VAERS ID: 620207 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: Foreign  
Vaccinated:2011-09-08
Onset:0000-00-00
Submitted: 2015-12-23
Entered: 2015-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 3 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Arthralgia, Back pain, Decreased activity, Dizziness, Dyspnoea, General physical health deterioration, Headache, Infection, Influenza, Influenza like illness, Insomnia, Muscular weakness, Nausea, Orthostatic intolerance, Pain, Photophobia, Pneumonia, Presyncope, Tic, Tilt table test positive, Tonsillitis
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Agranulocytosis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dyskinesia (broad), Dystonia (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow)

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: HPV immunisation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: At the border to meet the diagnostic criteria for POTS after a tilt table test.
CDC Split Type: WAES1512DNK011741

Write-up: Information has been received from Sanofi Pasteur MSD (MFR number # DK-1577272925-2015001185) on 22-DEC-2015. Case received from a physician on 17-DEC-2015 via the Agency under the case identification number DK-DKMA-WBS-0002050. A 13-year-old female adolescent patient received GARDASIL, (batch number unknown, Dose 1) via intramuscular route on 01-NOV-2010. Other suspect products included: GARDASIL, (batch number unknown, Dose 2) administrated via intramuscular route on 21-Mar-2011. GARDASIL, (batch number unknown, Dose 3) administered via intramuscular route on 08-SEP-2011. The patient experienced Influenza relapse / often influenza-like symptoms on an unknown date, Tonsillitis acute on an unknown date, Pneumonia on an unknown date, Orthostatic intolerance on an unknown date, Near syncope 27-NOV-2013, Headache on an unknown date, General body pain on an unknown date, Joint pain on an unknown date, Dizziness on an unknown date, Nausea on an unknown date, Acne on back on an unknown date, Dyspnea on an unknown date, Sleep difficult on an unknown date, tics eye on an unknown date, Muscle weakness generalized on an unknown date, Abdominal pain on an unknown date, Light sensitivity to eye on an unknown date, Recurrent infections on an unknown date, 6 months after dose 1 trouble with physical activity in 2011/5 months post injection and Reduced general condition on an unknown date. Other vaccines or medicines: unknown. At the border to meet the criteria for POTS after a tilt table test.


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