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This is VAERS ID 620364

Case Details

VAERS ID: 620364 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
Submitted: 2015-12-29
Entered: 2015-12-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Angiopathy, Arthralgia, Cognitive disorder, Constipation, Diarrhoea, Dizziness, Dry eye, Dyskinesia, Dyspnoea, Dysuria, Erythema, Fatigue, Headache, Hyperventilation, Muscular weakness, Myalgia, Nausea, Neuralgia, Orthostatic intolerance, Palpitations, Sleep disorder, Syncope, Tilt table test positive, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Asthma/bronchospasm (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Dyskinesia (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), 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), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (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: HPV immunisation
Preexisting Conditions:
Diagnostic Lab Data: Have examinations and/or laboratory tests been performed: Yes. Tilt table test shows orthostatic intolerance - but the patient does not fulfill the diagnostic criteria for POTS.
CDC Split Type: WAES1512DNK013343

Write-up: Information has been received from Sanofi Pasteur MSD (MFR Control number DK-1577272925-2015001515) on 28-DEC-2015. Case received from a physician via HA on 23-Dec-2015 under the reference number DK-DKMA-ADR 23286517 and DK-DKMA-WBS-0002223. A 13-year-old female adolescent patient received GARDASIL, (batch/lot number unknown, Dose 2) via intramuscular route on 29-Mar-2011, GARDASIL, (batch/lot number unknown, Dose 3) via intramuscular route on 02-Sep-2011, GARDASIL, (batch/lot number unknown) via intramuscular route on 10-Jan-2011. The patient experienced Syncopes in SEP-2012, Dizziness in SEP-2012, Fatigue in SEP-2012, Nausea on an unknown date, Headache on an unknown date, Neuropathic pain on an unknown date, Palpitation on an unknown date, Abdominal pain / abdominal cramps on an unknown date, Obstipation on an unknown date, Diarrhea on an unknown date, Voiding dysfunction on an unknown date, Skin coloring red on an unknown date, Dyspnoea on an unknown date, Hyperventilation on an unknown date, Sleep disorder on an unknown date, Cognitive dysfunction on an unknown date, Involuntary muscle movement on an unknown date, Limb weakness on an unknown date, Blurred vision on an unknown date, Vascular abnormalities on an unknown date, Muscle pain on an unknown date, Joint pain on an unknown date, Feeling bloated on an unknown date, Dry eyes on an unknown date and Orthostatic intolerance on an unknown date. 1 year after the 3rd vaccine the patient experiences syncopes, dizziness and tiredness. Subsequently, the other reported symptoms develop. Tilt table test showed orthostatic intolerance - but the patient does not fulfill the diagnostic criteria for POTS. The patient describes a lot of sick leave. At the time of reporting, the patient had not recovered from dry eyes, blurred vision, Involuntary muscle movement, Abdominal pain/abdominal cramps, Headache and syncopes. The outcome was unknown for the other reactions.

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