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This is VAERS ID 628872

Case Details

VAERS ID: 628872 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
Submitted: 2016-02-09
Entered: 2016-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Back pain, Blood test normal, Condition aggravated, General physical health deterioration, Headache, Neck pain, Neurological examination normal
SMQs:, Retroperitoneal fibrosis (broad), Arthritis (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: HPV Immunisation
Preexisting Conditions: 2009, Neck pain; 2009, Back pain
Diagnostic Lab Data: Blood test all normal; Neurological and rheumatological examinations normal, terminated
CDC Split Type: WAES1602DNK004576

Write-up: Information has been received from Sanofi Pasteur MSD (MFR number# DK-1577272925-2016000880) on 08-FEB-2016. Case received from a physician via health authority on 04-FEB-2016 under reference number DK-DKMA-WBS-0002565. A 12-year-old female adolescent patient received GARDASIL, (batch number unknown, Dose 1) via intramuscular route on 24-OCT-2012, GARDASIL, (batch number unknown) on 21-NOV-2012, GARDASIL, (batch number unknown) via intramuscular route on 22-MAY-2013. The patient experienced headache in 2012, aggravation of back pain in 2012, aggravation of neck pain in 2012 and the patient has a declining function level. She performs less sport and need to sleep during the day on an unknown date. The patient has had neck and back pain since 2009, but the pains has got worse after vaccination with GARDASIL. In addition the patient has developed headache, which now was the dominant symptom. Onset 2012 and got worse during 2013. Now less. The patient has after the vaccination declining function level. She do less sport and need to sleep during the day. There offered admission in interdisciplinary courses at local pediatric department. Blood test all normal. Neurological and rheumatological examinations normal, terminated. Other medicine or vaccines: No. The patient hade a medical history of: Back pain in 2009 and Neck pain in 2009. The patient''s outcome was reported as Not Recovered/Not Resolved except for reduced general condition which was reported as unknown.

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