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This is VAERS ID 628616

History of Changes from the VAERS Wayback Machine

First Appeared on 10/14/2016

628616
VAERS Form:
Age:12.0
Gender:Female
Location:Foreign
Vaccinated:2012-09-27
Onset:2012-12-01
Submitted:2016-03-22
Entered:2016-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Dizziness, Headache, Muscular weakness, Nausea, Blood test normal

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: No other medications
Current Illness: Human papilloma virus, immunisation
Preexisting Conditions:
Allergies:
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.


Changed on 9/14/2017

628616 Before After
VAERS Form:(blank) 1
Age:12.0
Gender:Female
Location:Foreign
Vaccinated:2012-09-27
Onset:2012-12-01
Submitted:2016-03-22
Entered:2016-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / - UNK UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Dizziness, Headache, Muscular weakness, Nausea, Blood test normal

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: No other medications
Current Illness: Human papilloma virus, immunisation
Preexisting Conditions:
Allergies:
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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