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This is VAERS ID 635166

Case Details

VAERS ID: 635166 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Foreign  
Vaccinated:2009-07-07
Onset:0000-00-00
Submitted: 2016-05-04
Entered: 2016-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 3 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain lower, Arthralgia, Blood test, Fatigue, Hyperacusis, Nausea, Nuclear magnetic resonance imaging, Somnolence
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hearing impairment (narrow), Arthritis (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: No other medications
Current Illness: Human papilloma virus immunisation
Preexisting Conditions: Memory impairment, has had memory problems throughout elementary school; Disturbance in attention, has had problems concentrating throughout elementary school.
Allergies:
Diagnostic Lab Data: Blood tests at GP; MRI of knee at an orthopedic clinic; Blood test, unknown; Nuclear magnetic resonance imaging, unknown
CDC Split Type: WAES1605DNK001557

Write-up: Note to MAH: Please do not return cases received from the Medicines Agency (DKMA) unless you received new information regarding the case. Please remember to use the Worldwide unique case identification number (A.1.10.1) for this case: DK-DKMA-WBS-0003221. Also, please note that information should not be deleted from the case (especially not the Patient Characteristics). Information has been received from Sanofi Pasteur MSD (SPMSD) (manufacturer control # DK-1577272925-2016004791) on 02-MAY-2016. Case received from a physician via HA on 27-Apr-2016. A 12-year-old female adolescent patient received GARDASIL (batch number Lot Not Rep) on 10-Mar-2008, GARDASIL (batch number Lot Not Rep) on 06-Jan-2009, GARDASIL (batch number Lot Not Rep) on 07-Jul-2009. The patient experienced tiredness in 2009, pain in knee in 2009, Sound sensitivity in 2010, nausea in 2011, Lower abdominal pain periodic in 2012 and Increased need of sleep in 2009. The patient had a medical history of disturbance in attention, memory impairment. The patient did not finish elementary school. Have had memory problems and problems concentrating throughout elementary school had to. Other vaccines: No. Other Medicines: No. Additional investigations included: Nuclear Magnetic Resonance Imaging n/a on an unknown date. Blood Test n/a on an unknown date. The patient''s outcome was reported as Not Recovered/Not Resolved.


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