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This is VAERS ID 628565

Case Details

VAERS ID: 628565 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
Vaccinated:2013-04-08
Onset:2013-09-10
   Days after vaccination:155
Submitted: 2016-02-03
   Days after onset:876
Entered: 2016-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H013137 / 2 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Abasia, Arthralgia, Asthenia, Disturbance in attention, Dizziness, Dysstasia, Fatigue, Headache, Hyperacusis, Insomnia, Myalgia, Phonophobia, Photophobia
SMQs:, Rhabdomyolysis/myopathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Hearing impairment (narrow), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1602IRL001173

Write-up: Information was received from Sanofi Pasteur MSD (IE-1577272925-2016000608) on 01-FEB-2016. This case was received from the health authority on 27-01-2016 under reference number IE-HPRA-2016-025696. Initial report was received by the RA on 12/Jan/2016 from a member of the public (patient''s mother) concerning a 13 year old female patient who experienced myalgia, arthralgia, asthenia, fatigue, headache, dysstasia, disturbance in attention, photophobia, phonophobia, dizziness and insomnia following vaccination with GARDASIL. Concomitant medications included BOOSTRIX. The patient also received a meningitis vaccine in 2012/2013. The patient''s medical history/concurrent conditions were not reported. The patient was vaccinated with GARDASIL (lot numbers H008259, expiration date not reported, on 25/Sep/2012 and H013137, expiration date 12-DEC-2010, on 8/Apr/2013) at an unspecified dose initially. The patient received all three doses of GARDASIL. On 10/Sep/2013, the patient developed muscle and joint pain, weakness all over her body, fatigue, headaches, an inability to walk or stand for very long, poor concentration, intolerance to light and noise, dizziness and insomnia. Corrective treatment included physiotherapy, DIFENE, SURMONTIL, NEURONTIN, acupuncture, massage, reiki and various other ''energy healing'' therapies. The patient outcome was reported as not recovered/not reported.


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