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This is VAERS ID 629628

History of Changes from the VAERS Wayback Machine

First Appeared on 3/14/2017

629628
VAERS Form:
Age:12.0
Gender:Female
Location:Foreign
Vaccinated:2013-05-03
Onset:0000-00-00
Submitted:2016-02-19
Entered:2016-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Back pain, Decreased activity, Headache, Muscle spasms, Musculoskeletal pain, Neck pain, Pyrexia, Loss of personal independence in daily activities

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: 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.


Changed on 9/14/2017

629628 Before After
VAERS Form:(blank) 1
Age:12.0
Gender:Female
Location:Foreign
Vaccinated:2013-05-03
Onset:0000-00-00
Submitted:2016-02-19
Entered:2016-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 3 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Back pain, Decreased activity, Headache, Muscle spasms, Musculoskeletal pain, Neck pain, Pyrexia, Loss of personal independence in daily activities

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: 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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