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This is VAERS ID 628616

Case Details

VAERS ID: 628616 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
   Days after vaccination:65
Submitted: 2016-03-22
   Days after onset:1206
Entered: 2016-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Blood test normal, Dizziness, Headache, Muscular weakness, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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:
Diagnostic Lab Data: Regular blood tests, substantially no abnormally.
CDC Split Type: WAES1603DNK008531

Write-up: Information has been received from Sanofi Pasteur MSD (MFR control number DK-DKMA-WBS-0002933) on 17-MAR-2016. Case received from a physician on 15-MAR-2016. A 12-year-old female adolescent patient received GARDASIL, (batch number unknown) via intramuscular route on 27-SEP-2012. The patient experienced nausea in December 2012, dizziness in December 2012, headache in December 2012 and weakness in the legs in December 2012. Additional investigations included Blood Test normal n/a on an unknown date. The patient''s outcome was reported as not recovered/not resolved. No other vaccines or medicines.

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