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This is VAERS ID 629697

Case Details

VAERS ID: 629697 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Foreign  
Submitted: 2016-02-26
Entered: 2016-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Dizziness, Fatigue, Menstrual disorder, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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: WAES1602IRL011235

Write-up: Information has been received from Sanofi Pasteur MSD (reference # IE-1577272925-2016001591) on 23-FEB-2016. This case was received from the health authority on 19-Feb-2016. Ref IE-HPRA-2016-025943. Initial report was received by the RA on 04/Feb/2016 from a member of the public (patient''s mother) which concerns a 13 year old female patient who experienced Dizziness, Nausea, Fatigue and Menstrual disorder following vaccination with GARDASIL (batch/lot # and expiration date not reported). Concomitant medications: None. Medical history/concurrent conditions: None reported. The patient was vaccinated with GARDASIL on 23/Sep/2011 and 21/Mar/2012. Post vaccination, the patient experienced dizziness, nausea, tiredness and menstrual problems that are ongoing to date. Corrective treatment: None reported.

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