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This is VAERS ID 635232

Case Details

VAERS ID: 635232 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
Submitted: 2016-05-05
Entered: 2016-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Activities of daily living impaired, Angiopathy, Cognitive disorder, Diarrhoea, Dizziness, Dyskinesia, Dyspnoea, Dysuria, Fatigue, General physical health deterioration, Headache, Hyperhidrosis, Influenza like illness, Malaise, Muscular weakness, Neuralgia, Oedema peripheral, Palpitations, Photophobia, Presyncope, Skin disorder, Sleep disorder, Syncope, Tilt table test normal, Vision blurred
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Dyskinesia (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), 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:
Diagnostic Lab Data: Test or examinations: Yes
CDC Split Type: WAES1605DNK001141

Write-up: Information has been received from Sanofi Pasteur MSD (SPM) (MFR Control No: DK-1577272925-2016004796) on 29-APR-2106. Case received from a physician via health authority on 28-Apr-2016 under reference number DK-DKMA-WBS-0003292. A 12-year-old female adolescent patient received GARDASIL (batch number unk, Dose 1) via intramuscular route on 22-Jan-2009, GARDASIL (batch number unk, Dose 2) via intramuscular route on 26-Mar-2009, GARDASIL (batch number unk, Dose 3) via intramuscular route on 11-Aug-2009. The patient experienced dyspnoea on an unknown date, flu like symptoms in MAR-2009, dizziness on an unknown date, limb weakness on an unknown date, cognitive dysfunction on an unknown date, utilpas in MAR-2009, fatigue on an unknown date, has completed education, but has bad, but with less character to follow on an unknown date, syncope on an unknown date, voiding dysfunction on an unknown date, abnormal sweating on an unknown date, skin problems on an unknown date, abdominal crampy pains on an unknown date, disordered sleep on an unknown date, headache on an unknown date, vascular abnormalities on an unknown date, involuntary muscle movement on an unknown date, blurred vision on an unknown date, oedema extremities on an unknown date, light sensitivity to eye on an unknown date, near syncope on an unknown date, nausea on an unknown date, neuropathic pain on an unknown date, the disease has had negative consequences on her social life on an unknown date, palpitations on an unknown date, diarrhea on an unknown date and reduced general function on an unknown date. After 2nd dose the patient experience malaise, afterwards the other reported reactions. During the tilt table test at syncope center the patient dose not fulfill the diagnostic criteria for POTS. The patient describes reduced general function. She has performed education, but with less character to follow. In addition has her disease had negative consequences for her social life. Other medicines or vaccines: Unknown. The outcome was reported as not recovered for impaired work ability and unknown for the other reported reactions.

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