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This is VAERS ID 628873

Case Details

VAERS ID: 628873 (history)  
Form: Version 1.0  
Age: 15.0  
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: Alopecia, Anxiety, Arthralgia, Asthenia, Blood test, Decreased appetite, Depression, Disturbance in attention, Dizziness, Dysaesthesia, Echocardiogram, Electrocardiogram ambulatory, Fatigue, Gastrointestinal motility disorder, Headache, Hypertension, Nausea, Nuclear magnetic resonance imaging, Pallor, Palpitations, Rash, Rash erythematous, Stress, Tilt table test, Tinnitus, Vomiting, Weight decreased
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal obstruction (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific dysfunction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (narrow), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Hypermobility syndrome
Diagnostic Lab Data: MR scanning, blood test, tilt table test, ECHO, Holter monitoring 24 h, blood pressure measurement
CDC Split Type: WAES1602DNK004545

Write-up: Information has been received from Sanofi Pasteur MSD [DK-1577272925-2016000881] on 08-FEB-2016. Case received from a physician via health authority on 04-FEB-2016 under reference number DK-DKMA-WBS-0002590. A 15-year-old female adolescent patient received GARDASIL (batch number unknown dose 1) via intramuscular route on 05-JAN-2009, GARDASIL (batch number unknown, Dose 2) via intramuscular route on 04-MAR-2009, GARDASIL (batch number NJ34850, Dose 3) via intramuscular route on 30-JUL-2009. The patient experienced depression on an unknown date, memory problems in 2012, anxiety on an unknown date, concentration problems in 2012, hair loss in 2013, Tinnitus in 2013, stress on an unknown date, pale in mouth in 2013, rash, red patches on chest and knobs in face in 2013, Hypertension in 2015, weight loss in 2010, nausea in 2010, joint pain in MAR-2009, tiredness in 2011, vomiting in 2010, alternating stool in 2011, palpation in 2011, dizziness in 2011, dysesthesia in 2011, reduced appetite in 2010, headache in April 2009 and loss of energy in 2011. Has been confirmed with anxiety, stress and depression and have been at centrum for functional disorders with severe Bodily distress syndrome (BDS). Investigations: MR scanning, blood test, tilt table test, ECHO, Holter monitoring 24 h, blood pressure measurement. The patient had a medical history of Hypermobility syndrome. No other vaccines or medicines. The patient''s outcome was reported as recovering for rash, nausea, reduced appetite and weight loss and Not Recovered/Not Resolved for the other reported reaction.

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