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This is VAERS ID 629743

Case Details

VAERS ID: 629743 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
Submitted: 2016-02-25
Entered: 2016-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Anxiety, Arthralgia, Cognitive disorder, Constipation, Depressed mood, Dizziness, Dry mouth, Dysgeusia, Dyspnoea, Headache, Loss of personal independence in daily activities, Menstrual disorder, Muscular weakness, Musculoskeletal pain, Myalgia, Nausea, Neuralgia, Pain in extremity, Panic attack, Peripheral coldness, Skin disorder, Sleep disorder, Social avoidant behaviour, Syncope, Tilt table test normal, Vision blurred, Weight increased
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (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 immunistaion
Preexisting Conditions:
Diagnostic Lab Data: Tilt table test showed a normal examination.
CDC Split Type: WAES1602DNK011144

Write-up: Case received from a physician via HA on 19-Feb-2016 under the reference number DK-DKMA-WBS-002754 and DK-DKMA-ADR 23360220. A 12-year-old female adolescent patient received GARDASIL, (batch number unknown, Dose 1) via intramuscular route on 23-Apr-2015. The patient experienced Pain in arm in APR-2015, Headache on an unknown date, Neuropathic pain on an unknown date, Syncope on an unknown date, Dizziness on an unknown date, Nausea on an unknown date, Abdominal pain on an unknown date, Obstipation on an unknown date, Skin disorder on an unknown date, Shortness of breath on an unknown date, Menstrual disorder on an unknown date, Sleep disorder on an unknown date, Cognitive disorder on an unknown date, Weakness of limbs / weakness of arms on an unknown date, Panic attack on an unknown date, Weight gain on an unknown date, Taste metallic on an unknown date, Cold hands on an unknown date, Joint pain on an unknown date, Muscle pain on an unknown date, Blurred vision on an unknown date, Dry mouth on an unknown date, pain in her shoulder in APR-2015, high absence on an unknown date, she isolates herself on an unknown date, Anxiety attack on an unknown date, feels depressed on an unknown date, feels depressed on an unknown date, patient isolated herself and has no social life on an unknown date and as a consequence of her symptoms she has now high absence on an unknown date. Patient describes that her symptom debut started 1-2 weeks after 1st vaccine, when she had pain in her shoulder and arm - so that she went to the physician with it. Subsequently, the other symptoms developed. Before the vaccines, she describes that she was a social girl, who strength trained every 2nd day and excelled in school. As a consequence of her symptoms, she has now high absence, she isolates herself, has no social life, develops anxiety attacks and feels depressed. Her schooling has also been affected. Tilt table test showed a normal examination. Other vaccines or medications: unknown. Additional investigations included Tilt Table Test normal examination n/a on an unknown date. At the time of reporting, the outcome was unknown for the reactions Pain in arm, Syncope, Menstrual disorder, Pain in her shoulder, high absence, she isolates herself, anxiety attack, feels depressed, feels depressed, patient isolated herself and has no social life, and as a consequence of her symptoms she has no high absence. The patient had not Recovered/Resolved from the other reactions.

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