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This is VAERS ID 620303

Case Details

VAERS ID: 620303 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
Vaccinated:2012-04-26
Onset:2012-05-01
   Days after vaccination:5
Submitted: 2015-12-28
   Days after onset:1336
Entered: 2015-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Arthralgia, Cognitive disorder, Dizziness, Dyskinesia, Dyspnoea, Dysuria, Fatigue, Headache, Hyperhidrosis, Hyperventilation, Influenza like illness, Loss of personal independence in daily activities, Menstruation irregular, Muscle spasms, Muscular weakness, Nausea, Photophobia, Sleep disorder, Syncope, Tilt table test normal, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Dyskinesia (narrow), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Vestibular disorders (broad), Fertility disorders (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Hypoglycaemia (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: HPV immunisation; Immunisation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: during tilt table test the patient does not fulfill the diagnostic criteria for POTS.
CDC Split Type: WAES1512DNK011882

Write-up: Information has been received from Sanofi Pasteur MSD (MFR # 2015001354) on 23-DEC-2015. Flu like symptoms, Dizziness, Headache, Fatigue extreme, Involuntary muscle movement, Joint pain, Nausea, Abdominal pain, Dyspnoea, Irregular menstruation, Hyperventilation, Sleep disorder, Blurred vision, Sweating abnormal, Cramps, Recurrent syncope, Voiding dysfunction, Cognitive dysfunction, Limb weakness, Light sensitivity to eyes. Case received from a physician via health authority on 21-Dec-2015 under reference number DK-DKMA-WBS-0002070 and DK-DKMA-ADR 23279872. A 12-year-old female adolescent patient received GARDASIL, (batch number unknown) via intramuscular route on 26-Apr-2012, GARDASIL, (batch number unknown) via intramuscular route on 03-Jul-2012, GARDASIL, (batch number unknown) via intramuscular route on 03-Apr-2013. The patient received concomitant administration of PRIORIX 1 DF on an unknown date. The patient experienced Flu like symptoms in MAY-2012/1 Weeks post injection, Dizziness in MAY-2012/1 Weeks post injection, Headache in MAY-2012/1 Weeks post injection, Fatigue extreme in MAY-2012/1 Weeks post injection, Involuntary muscle movement on an unknown date, Joint pain on an unknown date, Recurrent syncope on an unknown date, Nausea on an unknown date, Abdominal pain on an unknown date, Voiding dysfunction on an unknown date, Dyspnoea on an unknown date, Irregular menstruation on an unknown date, Hyperventilation on an unknown date, Sleep disorder on an unknown date, Cognitive dysfunction on an unknown date, Limb weakness on an unknown date, Sleep disorder on an unknown date, Cognitive dysfunction on an unknown date, Limb weakness on an unknown date, Blurred vision on an unknown date, Sweating abnormal on an unknown date, Light sensitivity to eyes on an unknown date, Cramps on an unknown date and reduced function on an unknown date. 7 days later first dose flu like symptoms, headache, dizziness and tiredness. Afterwards the other reported symptoms. During tilt table test she does no fulfill the diagnostic criteria for POTS. The patient describes reduced function and has a lot of sick leave from school (class 6 to 9). The patient was admitted to hospital on an unspecified date. The patient''s outcome was reported as Not Recovered/Not Resolve.


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