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This is VAERS ID 629628

Case Details

VAERS ID: 629628 (history)  
Form: Version 1.0  
Age: 12.0  
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: Back pain, Decreased activity, Headache, Loss of personal independence in daily activities, Muscle spasms, Musculoskeletal pain, Neck pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Dystonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (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? 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: No examinations or lab test
CDC Split Type: WAES1602DNK009285

Write-up: Information has been received from Sanofi Pasteur MSD (MFR control number DK-1577272925-2016001331) on 18-FEB-2016. Case received from a physician via health authority on 16-FEB-2016 under reference number DK-DKMA-WBS-0002706. A 12-year-old female adolescent patient received GARDASIL, batch number unknown Dose 1 via intramuscular route on 02-OCT-2012, GARDASIL, lot/batch number unknown, Dose 2 via intramuscular route on 14-DEC-2012, GARDASIL, batch number unknown, Dose 3 via intramuscular route on 03-MAY-2013. The patient experienced Musculoskeletal pain in 2013, muscle cramps in lower leg in 2013, fever in October 2012, headache in October 2012 discontinued leisure activity taekwondo on an unknown date, limited activity level on an unknown date, pain in neck in 2013 and pain in back in 2013. 10-12 days after first dose episode with headache and fever. 1/2 year later onset of muscoskeletal symptoms with neck and back pain that limits the activity level (shorter school days, discontinued leisure activity taekwondo) accompanying headache. The patient''s outcome was reported as Not Recovered/Not Resolved except for fever and discontinued leisure activity taekwondo and limited activity level that was reported as unknown.

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