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This is VAERS ID 629623

Case Details

VAERS ID: 629623 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Foreign  
Submitted: 2016-02-19
Entered: 2016-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Arthralgia, Cognitive disorder, Fatigue, Headache, Pyrexia, Skin striae
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Immunisation
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1602IRL009236

Write-up: Information has been received from Sanofi Pasteur (MSD) (SPM) (MFR control number IE-1577272925-2016001389) on 18-FEB-2016. This case was received from the health authority on 16-FEB-2016 under reference number IE-HPRA-2016-025878. Initial report was received by the RA on 01-FEB-2016 from a member of the public (patient''s mother and also a HCP) which concerns a 13 year old female patient who experienced Fatigue, Arthralgia, Skin striae, Abdominal pain, Pyrexia, Headache and Cognitive disorder following vaccination with GARDASIL. Concomitant medications: None. Medical history/concurrent conditions: Nil. The patient was vaccinated with 3 doses of GARDASIL via IM route, including one dose received on 19-SEP-2011 (only one vaccination date provided). Approximately 4 weeks post vaccination, the patient experienced chronic fatigue, joint pains, stretch marks, severe headaches, reduced cognition, abdominal pain and pyrexia. The reporter indicated that the patient has had multiple hospital admissions and multiple GP and consultant visits. At the time of reporting the patient''s symptoms were persisting. The patient outcome was reported as not recovered/not resolved.

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