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This is VAERS ID 635122

Case Details

VAERS ID: 635122 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Foreign  
Vaccinated:2015-03-24
Onset:0000-00-00
Submitted: 2016-05-05
Entered: 2016-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J007883 / UNK UN / IM
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER 967011 / UNK UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain upper, Asthenia, Blood test, Dizziness, Dyspnoea, Headache, Hypotension, Malaise, Menstruation irregular, Oropharyngeal pain, Pruritus generalised, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Fertility disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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:
Current Illness: Prophylaxis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Blood pressure results (unknown date): low; Blood test, not reported
CDC Split Type: WAES1605IRL002335

Write-up: Information has been received from Sanofi Pasteur MSD (MFR number 2016004947) on 04-MAY-2016. This case was received from RA (Ref no. IE-HPRA-2016-026543) on 29-APR-2016. Initial case received from a physician. A 15-year-old female adolescent patient received GARDASIL (batch number: J007883) and MENJUGATE KIT (batch number 967011) administered via intramuscular route on 24-MAR-2015. Concomitant medications: None. Medical history/concurrent conditions: Not reported. The patient experienced unwell, menstrual irregularity, headaches, dizziness, breathlessness, pains and soreness all over, pains in stomach, recurrent sore throats, low blood pressure, fainted and loss of energy on an unknown date. The patient fainted recently when having a blood test. The reporter indicated that the patient has missed a lot of school. The reporter assessed the causal relationship: between stomach pain, sore throat, low blood pressure, faint, loss of energy, unwell, menstrual irregularity, headache, dizziness, breathlessness, pain and GARDASIL as unknown. The patient''s outcome was reported as not recovered/not resolved.


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