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This is VAERS ID 620649

Case Details

VAERS ID: 620649 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
   Days after vaccination:14
Submitted: 2016-01-13
   Days after onset:761
Entered: 2016-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Alopecia, Arthralgia, Arthritis infective, Cognitive disorder, Dizziness postural, Dyspnoea, Dysuria, Fatigue, Food allergy, Headache, Hypermobility syndrome, Influenza like illness, Loss of personal independence in daily activities, Muscle strain, Muscular weakness, Myalgia, Nausea, Neuralgia, Oropharyngeal pain, Palpitations, Pharyngitis, Skin disorder, Sleep disorder, Syncope, Tilt table test normal
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Agranulocytosis (broad), Peripheral neuropathy (narrow), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Oropharyngeal infections (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: Immunisation
Preexisting Conditions: Muscle strain, she must stop dance
Diagnostic Lab Data: Tile table test (unspecified date): normal, not provided
CDC Split Type: WAES1601DNK003603

Write-up: Information has been received from Sanofi Pasteur (MSD) (SPM) (manufacturer control # 2016000077) as part of business agreement on 12-JAN-2016. Case received from a physician via health authority on 07-Jan-2016 under reference number DK-DKMA-WBS-0002319. A 13-year-old female adolescent patient received GARDASIL, (batch number unknown, Dose 1) via intramuscular route on 29-Nov-2013, GARDASIL, (batch number unknown, Dose 2) via intramuscular route on 31-Jan-2014. The patient received concomitant administration of M-M-RVAXPRO on 29-Nov-2013. The patient experienced Sore throat (throat infections) on 13-DEC-2013, Flu like symptoms on 13-DEC-2013, Hip infection on 14-FEB-2014, Headache on an unknown date, Syncope one time on an unknown date, Neuropathic pain on an unknown date, Dizziness on standing up on an unknown date, Palpitation on an unknown date, Nausea on an unknown date, Abdominal pain on an unknown date, Voiding difficulty on an unknown date, Skin disorder on an unknown date, Hair loss on an unknown date, Dyspnoea on an unknown date, Sleep disorder on an unknown date, Cognitive disorder on an unknown date, Weakness of arms and Weakness of limbs on an unknown date, hypermobile on an unknown date, Food hypersensitivity on an unknown date, Fatigue on an unknown date, Joint pain on an unknown date, Muscle pain on an unknown date and she has previously danced on elite level, but was very exhausted after competitions on an unknown date. Symptom starts around 14 days after first dose, with influenza like symptoms and throat infections. 14 days after dose 2 the patient develop hip infection. 3 dose not given. She has previously danced on elite level, but got exhausted after competitions. In January 2014, she experience a injury in the right groin and she need to stop dance. Tilt table test normal findings. Other medicines: unknown. The patient''s outcome was reported as Not Recovered/Not Resolved.

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