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This is VAERS ID 632624

Case Details

VAERS ID: 632624 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Male  
Location: Washington  
Vaccinated:2015-06-25
Onset:2015-06-25
   Days after vaccination:0
Submitted: 2016-04-23
   Days after onset:303
Entered: 2016-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. K006960 / 1 UN / SYR

Administered by: Private       Purchased by: Other
Symptoms: Activities of daily living impaired, Arthralgia, Blood test, Dizziness, Fatigue, Headache, Malaise, Muscular weakness, Nausea, Pain in extremity, Vomiting, X-ray, X-ray with contrast upper gastrointestinal tract
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament 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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Omeprazole
Current Illness: Yearly physical
Preexisting Conditions: Ulcer
Allergies:
Diagnostic Lab Data: X-rays, upper GI, blood work
CDC Split Type:

Write-up: Vomting, joints hurt, frequent headaches, general feeling of unwell, feeling dizzy, painful hands, feet, arms, legs, nausea, muscle weakness, tiredness, missing more school from not feeling good.


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