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This is VAERS ID 635288

Case Details

VAERS ID: 635288 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: Foreign  
   Days after vaccination:33
Submitted: 2016-05-05
   Days after onset:2711
Entered: 2016-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Abdominal distension, Abdominal pain, Activities of daily living impaired, Angiopathy, Cognitive disorder, Dizziness, Dry eye, Dyskinesia, Dyspnoea, Fatigue, Headache, Heart rate increased, Loss of consciousness, Muscular weakness, Nausea, Neuralgia, Orthostatic intolerance, Palpitations, Photophobia, Sleep disorder, Tilt table test normal, Vision blurred, Visual impairment
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), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (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), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data: Have examinations and/or laboratory tests been conducted: Yes. Tilt Table Test: The patient does not meet the diagnostics criteria for POTS but it showed high resting heart rate. On an unknown date the patient experienced high resting heart rate.
CDC Split Type: WAES1605DNK002329

Write-up: Information has been received from Agency (DKMA) (DK-DKMA-WBS 0003322) via SPMSD (manufacturer control # DK-1577272925-2016004920) on 04-MAY-2016. Case received from a physician on 29-APR-2016. A 14-year-old female adolescent patient received GARDASIL (batch number lot not rep, Dose 1) via intramuscular route on 29-OCT-2008, GARDASIL (batch number lot not rep, Dose 2) via intramuscular route on 02-JAN-2009, GARDASIL (batch number lot not rep, Dose 3) via intramuscular route on 14-MAY-2009. the patient experienced blurred vision on 01-DEC-2008, fatigue extreme on an unknown date, orthostatic intolerance on an unknown date, High resting heart rate on an unknown date, headache on an unknown date, neuropathic pain on an unknown date, blacked out on an unknown date, dizziness on an unknown date, palpitations on an unknown date, nausea on an unknown date, abdominal pain on an unknown date, dyspnea on an unknown date, disordered sleep on an unknown date, Cognitiv dysfunction on an unknown date, involuntary muscle movement on an unknown date, limb weakness on an unknown date, vascular abnormalities on an unknown date, dry eyes on an unknown date, feeling bloated on an unknown date, light sensitivity to eyes on an unknown date, impaired functioning on an unknown date and have been absent from school a lot due to sickness. the school year 2008/2009 she was on sick leave for 3 months. Have had to abandon training and tried to so Higher Preparatory Examination on an unknown date. Approximately 1 month after the first vaccination the patient experienced that she found it difficult to see and focus her eyes. Subsequently, the other reported symptoms followed. According to a tilt table test at our office the patient does not fulfill the diagnostic criteria for POTS, however shows a high resting heart rate. Clinically appearance of a patient with orthostatic intolerance. Patient reports decreased level of functioning and a lot of sick leave. During the school year 2008/2009, she was on sick leave for three months. Has had to abandon training and tried to do Higher Preparatory Examination in single subjects. Other vaccines: Do not know. Other Medicines: Do not know. the patient was admitted to hospital on an unspecified date. Additional investigations included Tilt table test not meet POTS criteria on an unknown date. the patient''s outcome was reported as Not Recovered/Not Resolved.

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