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This is VAERS ID 628400

Case Details

VAERS ID: 628400 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2016-01-29
Entered: 2016-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 3 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Activities of daily living impaired, Dizziness, Fatigue, Headache, Nausea, Pain, Tic
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Dyskinesia (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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: Human papilloma virus immunisation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1601DNK011080

Write-up: Information has been received from Sanofi Pasteur MSD (SPM) (manufacturer control # DK-1577272925-2016000507) as part of business agreement on 28-JAN-2016. Case received from a lawyer at patient insurance company via health authority on 25-Jan-2016 under reference number DK-DKMA-ADR 23324194. The health authority has received the patient''s initial notification under reference number 15-6079. The patient''s insurance has not taken a decision in the case. A female patient of unknown age received GARDASIL (batch number unknown, dose 1) in 2008, GARDASIL (batch number unknown, dose 2) in 2008, GARDASIL (batch number unknown, dose 3) in 2008. The patient experienced tiredness on an unknown date, pain on an unknown date, nausea on an unknown date, dizziness on an unknown date, headache on an unknown date, tics at the eyes on an unknown date, abdominal pain on an unknown date and had to give up high school on an unknown date. The patient received 3 doses in 2008 and developed thereafter the reported reactions, which led to that she had to give up high school. The patient has not recovered.


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