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This is VAERS ID 620715

Case Details

VAERS ID: 620715 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
Vaccinated:2010-06-30
Onset:0000-00-00
Submitted: 2016-01-18
Entered: 2016-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 3 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Appetite disorder, Constipation, Diarrhoea, Dizziness, Dyskinesia, Dysmenorrhoea, Dyspnoea, Exercise tolerance decreased, Food intolerance, Muscle fatigue, Muscular weakness, Myalgia, Nausea, Palpitations, Photophobia, Pollakiuria, Pruritus, Sleep disorder, Temperature regulation disorder, Tilt table test normal, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Dyskinesia (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Have examination and/or laboratory tests been performed: Yes; Result of Tilt table test was normal; Body temperature (date unknown): disorder.
CDC Split Type: WAES1601DNK005224

Write-up: Information has been received from Sanofi Pasteur MSD (SPM) (MFR# DK-1577272925-2016000226) on 15-JAN-2015. Case received from a physician via HA on 13-Jan-2016 under the reference number DK-DKMA-WBS-0002366 and DK-DKMA-ADR 23308286. A 13-year-old female adolescent patient received GARDASIL, (batch number unknown, Dose 1) via intramuscular route on 28-Aug-2009, GARDASIL, (batch number unknown, Dose 2) via intramuscular route on 06-Nov-2009, GARDASIL, (batch number unknown, Dose 3) via intramuscular on 30-Jun-2010. The patient experienced Dizziness in OCT-2013, Hyperventilation in OCT-2013, Muscle pain on an unknown date, Itching on an unknown date, Palpitation on an unknown date, Nausea on an unknown date, Satiety changed on an unknown date, Frequency urinary on an unknown date, Hives on an unknown date, Shortness of breath on an unknown date, Pain menstrual in JAN-2011, Sleep disorder on an unknown date, Fatigue on an unknown date, Involuntary muscle movement on an unknown date, Weakness of limbs on an unknown date, Food intolerance on an unknown date, Temperature regulation disorder on an unknown date, Diarrhea on an unknown date, Obstipation on an unknown date, Eyes sensitive to bright light on an unknown date, jumping rope at elite level. Still jumps rope but with pauses in between on an unknown date and Muscle fatigue on an unknown date. Additional investigations included Tilt Table Test normal n/a on an unknown date. At the time of reporting, the patient had not recovered from Dizziness, Palpitation, Sleep disorder, Temperature regulation disorder and Eyes sensitive to bright light. The patient was recovering/resolving from muscle fatigue, jumping rope at elite level, still jumps rope but with pauses in between and Weakness of limbs. The outcome was unknown for the other reactions.


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