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This is VAERS ID 620649

History of Changes from the VAERS Wayback Machine

First Appeared on 4/14/2017

620649
VAERS Form:
Age:12.0
Gender:Female
Location:Foreign
Vaccinated:2013-11-29
Onset:2013-12-13
Submitted:2016-01-13
Entered:2016-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Alopecia, Arthralgia, Dizziness postural, Dyspnoea, Dysuria, Fatigue, Food allergy, Headache, Hypermobility syndrome, Influenza like illness, Muscular weakness, Myalgia, Nausea, Neuralgia, Palpitations, Pharyngitis, Skin disorder, Sleep disorder, Syncope, Muscle strain, Cognitive disorder, Arthritis infective, Oropharyngeal pain, Tilt table test normal, Loss of personal independence in daily activities

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: Immunisation
Preexisting Conditions: Muscle strain, she must stop dance
Allergies:
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.


Changed on 9/14/2017

620649 Before After
VAERS Form:(blank) 1
Age:12.0
Gender:Female
Location:Foreign
Vaccinated:2013-11-29
Onset:2013-12-13
Submitted:2016-01-13
Entered:2016-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 1 UN / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Alopecia, Arthralgia, Dizziness postural, Dyspnoea, Dysuria, Fatigue, Food allergy, Headache, Hypermobility syndrome, Influenza like illness, Muscular weakness, Myalgia, Nausea, Neuralgia, Palpitations, Pharyngitis, Skin disorder, Sleep disorder, Syncope, Muscle strain, Cognitive disorder, Arthritis infective, Oropharyngeal pain, Tilt table test normal, Loss of personal independence in daily activities

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: Immunisation
Preexisting Conditions: Muscle strain, she must stop dance
Allergies:
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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