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This is VAERS ID 620347

Case Details

VAERS ID: 620347 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Foreign  
Submitted: 2015-12-28
Entered: 2015-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Alopecia, Angiopathy, Chest pain, Cognitive disorder, Dizziness, Dry eye, Dry skin, Dyskinesia, Dyspnoea, Fatigue, Headache, Heart rate increased, Hyperhidrosis, Loss of personal independence in daily activities, Mood altered, Muscular weakness, Nausea, Palpitations, Photophobia, Pollakiuria, Sleep disorder, Tilt table test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (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), 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), Corneal disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Hypoglycaemia (broad), Dehydration (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? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: HPV immunisation; Immunisation; Fatigue, tiredness during the day; Hallucination, nightly hallucinations; Nightmare; Poor quality sleep, she is bother by bad sleep; Epilepsy, epilepsy since childhood
Preexisting Conditions:
Diagnostic Lab Data: During tilt table test is a significant heart rate increase seen when moving to standing, but does not fulfill the criteria for POTS.
CDC Split Type: WAES1512DNK011973

Write-up: Information has been received from Sanofi Pasteur MSD (reference # DK-1577272925-2015001352) on 22-DEC-2015. Case received from a physician via health authority on 21-Dec-2015 under reference number DK-DKMA-WBS-0002068. A 12-year-old female adolescent patient received GARDASIL, (batch/lot number, expiration date unknown, Dose 1) via intramuscular route on 25-Aug-2011, GARDASIL, (batch/lot number, expiration date unknown, Dose 2) via intramuscular route on 23-Jan-2012, GARDASIL, (batch/lot number, expiration date unknown, Dose 3) via intramuscular route on 24-May-2012. The patient received concomitant administration of PRIORIX 1 DF on an unknown date. The patient experienced Headache in AUG-2011, Abdominal pain on an unknown date, Vascular abnormalities on an unknown date, Chest pain on an unknown date, Dizziness on an unknown date, Palpitation on an unknown date, Nausea on an unknown date, Frequent urination on an unknown date, Dry scalp on an unknown date, Shortness of breath on an unknown date, Sleep disorder on an unknown date, Fatigue extreme on an unknown date, Cognitive disorder on an unknown date, Involuntary muscle movement on an unknown date, Weakness of legs on an unknown date, Hair loss on an unknown date, Mood change on an unknown date, Dry eyes on an unknown date, Sweating abnormal on an unknown date, Light sensitivity to eye on an unknown date and during tilt table test is a significantly heart rate increase seen when moving to standing. On an unknown date. One week after vaccination, the patient experience headache, it has been worse and worse over time. Afterwards onset of the other reported symptoms. The patient has a lot of absence from school and is followed at headache clinic. Epilepsy since childhood. She has been bothered by bad sleep, tiredness during the day, nightmares and nightly hallucinations. She is from the syncope center referred to sleep clinic. Other medicines: unknown. The patient had a medical history of: Epilepsy, poor quality sleep, nightmare, fatigue. Additional investigations included: During tilt table test is a significant heart rate increase seen when moving to standing, but does not fulfill the criteria for POTS. The patient''s outcome was reported as Not Recovered/Not Resolved.

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