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This is VAERS ID 620675

History of Changes from the VAERS Wayback Machine

First Appeared on 4/14/2017

620675
VAERS Form:
Age:13.0
Gender:Female
Location:Foreign
Vaccinated:2014-10-30
Onset:2014-10-30
Submitted:2016-01-12
Entered:2016-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Alopecia, Anxiety, Fatigue, Feeling abnormal, Flushing, Gastrointestinal disorder, Hyperaesthesia, Hypoaesthesia, Menstrual disorder, Nausea, Pallor, Tremor, Limb discomfort, Oropharyngeal pain

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:
Current Illness: Unknown
Preexisting Conditions: 05/2014, Fatigue; Meningococcal Polysaccharide C; GARDASIL; GARDASIL
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': IE2016002639

Write-up:This case was reported by a consumer via regulatory authority and described the occurrence of arm discomfort in a 13-year-old female patient who received BOOSTRIX. Co-suspect products included GARDASIL (batch number KO08119, expiry date February 2017, GARDASIL (batch number KO17040, expiry date November 2016) and meningococcal polysaccharide c. The patient''s past medical history included fatigue. On an unknown date, the patient received BOOSTRIX at an unknown dose. On 30th October 2014, the patient received the 1 dose of GARDASIL at an unknown dose and frequency. On 22nd May 2015, the patient the second dose of GARDASIL at an unknown dose and frequency. On an unknown date, the patient started meningococcal polysaccharide c at an unknown dose and frequency. On 30th October 2014, an unknown time after receiving BOOSTIX, and less a day after receiving the 1st dose of GARDASIL, the patient experienced arm discomfort (serious criteria disability), chronic fatigue (serious criteria disability), numbness in leg (serious criteria disability) and nausea (serious criteria disability). On an unknown date, the patient experienced menstrual disorder (serious criteria disability), gastrointestinal disorder (serious criteria disability), feeling foggy in head (serious criteria disability), hair loss (serious criteria disability), tremor (serious criteria disability), sore throat (serious criteria disability), pallor (serious criteria disability), flushing (serious criteria disability), anxiety (serious criteria disability) and touch sensitivity increased (serious criteria disability). On an unknown date, the outcome of the arm discomfort, chronic fatigue, numbness in leg, nausea, menstrual disorder, gastrointestinal disorder, foggy feeling in head, hair loss, tremor, sore throat, pallor, flushing, anxiety and touch sensitivity increased were not recovered/not resolved. It was unknown if the reporter considered the arm discomfort, chronic fatigue, numbness in leg, nausea, menstrual disorder, gastrointestinal disorder, foggy feeling in head, hair loss, tremor, sore throat, pallor, flushing, anxiety and touch sensitivity increased to be related to BOOSTRIX. RA Verbatim: 08-JAN-2016. Initial report was received by the HPRA on 26/Dec/2015 from a member of the public which concerns a 13 year old female patient who experienced Limb discomfort, Fatigue, Hypoasthesia, Nausea and Anxiety following vaccination with GARDASIL, BOOSTIX and MEN C vaccine (brand unspecified). Concomitant medications: None. Medical history/concurrent conditions: The reporter indicated that the patient was in good health apart from an episode of fatigue in May/2014 that was possibly related to a virus. The patient was vaccinated with two doses of GARDASIL on both 30/Oct/2014 and 22/May/2015 (batch no.''s KO08119 exp. date 02/17 and K017040 exp 11/16 respectively). BOOSTRIX and MEN C vaccine were also given at this time. Post vaccination, on 30/Oct/2014, the patient experienced sore arms, exhaustion, numb legs and nausea. In addition the patient also experienced chronic fatigue, menstrual problems, gastrointestinal problems, brain fog, hair loss, shaking, anxiety, sore throat, pale/flushed appearance and was sensitive to touch. The reported added that the patient had a much more serious reaction to her second dose of the vaccine. Corrective treatment: Complete rest. At the time of reporting the patient''s symptoms were persisting.


Changed on 9/14/2017

620675 Before After
VAERS Form:(blank) 1
Age:13.0
Gender:Female
Location:Foreign
Vaccinated:2014-10-30
Onset:2014-10-30
Submitted:2016-01-12
Entered:2016-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 0 1 UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Alopecia, Anxiety, Fatigue, Feeling abnormal, Flushing, Gastrointestinal disorder, Hyperaesthesia, Hypoaesthesia, Menstrual disorder, Nausea, Pallor, Tremor, Limb discomfort, Oropharyngeal pain

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:
Current Illness: Unknown
Preexisting Conditions: 05/2014, Fatigue; Meningococcal Polysaccharide C; GARDASIL; GARDASIL
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': IE2016002639

Write-up:This case was reported by a consumer via regulatory authority and described the occurrence of arm discomfort in a 13-year-old female patient who received BOOSTRIX. Co-suspect products included GARDASIL (batch number KO08119, expiry date February 2017, GARDASIL (batch number KO17040, expiry date November 2016) and meningococcal polysaccharide c. The patient''s past medical history included fatigue. On an unknown date, the patient received BOOSTRIX at an unknown dose. On 30th October 2014, the patient received the 1 dose of GARDASIL at an unknown dose and frequency. On 22nd May 2015, the patient the second dose of GARDASIL at an unknown dose and frequency. On an unknown date, the patient started meningococcal polysaccharide c at an unknown dose and frequency. On 30th October 2014, an unknown time after receiving BOOSTIX, and less a day after receiving the 1st dose of GARDASIL, the patient experienced arm discomfort (serious criteria disability), chronic fatigue (serious criteria disability), numbness in leg (serious criteria disability) and nausea (serious criteria disability). On an unknown date, the patient experienced menstrual disorder (serious criteria disability), gastrointestinal disorder (serious criteria disability), feeling foggy in head (serious criteria disability), hair loss (serious criteria disability), tremor (serious criteria disability), sore throat (serious criteria disability), pallor (serious criteria disability), flushing (serious criteria disability), anxiety (serious criteria disability) and touch sensitivity increased (serious criteria disability). On an unknown date, the outcome of the arm discomfort, chronic fatigue, numbness in leg, nausea, menstrual disorder, gastrointestinal disorder, foggy feeling in head, hair loss, tremor, sore throat, pallor, flushing, anxiety and touch sensitivity increased were not recovered/not resolved. It was unknown if the reporter considered the arm discomfort, chronic fatigue, numbness in leg, nausea, menstrual disorder, gastrointestinal disorder, foggy feeling in head, hair loss, tremor, sore throat, pallor, flushing, anxiety and touch sensitivity increased to be related to BOOSTRIX. RA Verbatim: 08-JAN-2016. Initial report was received by the HPRA on 26/Dec/2015 from a member of the public which concerns a 13 year old female patient who experienced Limb discomfort, Fatigue, Hypoasthesia, Nausea and Anxiety following vaccination with GARDASIL, BOOSTIX and MEN C vaccine (brand unspecified). Concomitant medications: None. Medical history/concurrent conditions: The reporter indicated that the patient was in good health apart from an episode of fatigue in May/2014 that was possibly related to a virus. The patient was vaccinated with two doses of GARDASIL on both 30/Oct/2014 and 22/May/2015 (batch no.''s KO08119 exp. date 02/17 and K017040 exp 11/16 respectively). BOOSTRIX and MEN C vaccine were also given at this time. Post vaccination, on 30/Oct/2014, the patient experienced sore arms, exhaustion, numb legs and nausea. In addition the patient also experienced chronic fatigue, menstrual problems, gastrointestinal problems, brain fog, hair loss, shaking, anxiety, sore throat, pale/flushed appearance and was sensitive to touch. The reported added that the patient had a much more serious reaction to her second dose of the vaccine. Corrective treatment: Complete rest. At the time of reporting the patient''s symptoms were persisting.


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