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This is VAERS ID 620207

History of Changes from the VAERS Wayback Machine

First Appeared on 5/14/2017

620207
VAERS Form:
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. - / 2 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Arthralgia, Back pain, Decreased activity, Dizziness, Dyspnoea, Headache, Infection, Influenza, Influenza like illness, Insomnia, Muscular weakness, Nausea, Pain, Photophobia, Pneumonia, Presyncope, Tic, Tonsillitis, General physical health deterioration, 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)? No
ER or ED Visit? (V2.0) 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.


Changed on 9/14/2017

620207 Before After
VAERS Form:(blank) 1
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. - / 2 3 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Arthralgia, Back pain, Decreased activity, Dizziness, Dyspnoea, Headache, Infection, Influenza, Influenza like illness, Insomnia, Muscular weakness, Nausea, Pain, Photophobia, Pneumonia, Presyncope, Tic, Tonsillitis, General physical health deterioration, 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)? No
ER or ED Visit? (V2.0) 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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