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This is VAERS ID 629651

Case Details

VAERS ID: 629651 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
Vaccinated:2008-10-08
Onset:2008-12-01
   Days after vaccination:54
Submitted: 2016-02-23
   Days after onset:2640
Entered: 2016-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 3 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Abdominal infection, Abdominal pain, Cognitive disorder, Constipation, Cystitis, Dizziness, Dry skin, Dyskinesia, Fatigue, Headache, Influenza, Loss of personal independence in daily activities, Muscular weakness, Nausea, Neuralgia, Palpitations, Sleep disorder, Syncope, Tilt table test normal
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Dyskinesia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Infective pneumonia (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: Human papilloma virus immunisation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Tilt table test showed a normal examination.
CDC Split Type: WAES1602DNK010216

Write-up: Case received from a physician via HA on 17-Feb-2016 under the reference number DK-DKMA-ADR 23357899 and DK-DKMA-WBS-0002729. A 13-year old female adolescent patient received GARDASIL, (batch number unknown, Dose 1) via intramuscular route on 08-Oct-2008, GARDASIL, (batch number unknown, Dose 2) via intramuscular route on an unknown date, GARDASIL, (batch number unknown, Dose 3) via intramuscular route on an unknown date. The patient experienced abdominal pain in Dec-2008, Headache on an unknown date, Neuropathic pain on an unknown date, Syncope on an unknown date, Dizziness on an unknown date, Palpitation on an unknown date, Nausea on an unknown date, Obstipation on an unknown date, Dry scalp on an unknown date, Sleep disorder on an unknown date, Fatigue on an unknown date, Cognitive disorder on an unknown date, Involuntary muscle movement on an unknown date, Weakness of limbs on an unknown date, Frequent cystitis on an unknown date, Had to drop out of school 2 times on an unknown date, Frequent abdominal infections on an unknown date, develops often influenza on an unknown date and the patient had a normal activity level until her vaccinations on an unknown date. The patient was admitted to hospital on an unspecified date. The patient describes that her symptom debut started 2 months after the 1st vaccination: Abdominal pain: After 3rd vaccine the patient developed headache and tiredness. The remaining symptoms develop subsequently. After vaccination the patient develops often cystitis, abdominal infections and influenza. The patient had normal activity level until her vaccinations. As a consequence of the symptoms the patient had to drop out of school 2 times. A tilt table test showed a normal examination. Other vaccines: Unknown. Other Medications: Unknown. Additional investigations included Tilt Table Test normal n/a on an unknown date. At the time of reporting, the patient had Not recovered/resolved from abdominal pain, Syncope, Dizziness and Palpitation. The outcome was unknown for the other reactions.


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