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This is VAERS ID 635400

Case Details

VAERS ID: 635400 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: Foreign  
   Days after vaccination:91
Submitted: 2016-05-09
   Days after onset:2412
Entered: 2016-05-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Activities of daily living impaired, Arthralgia, Back pain, Discomfort, Disturbance in attention, Dizziness postural, Fatigue, Headache, Infection susceptibility increased, Influenza like illness, Muscle contractions involuntary, Muscle spasms, Nausea, Oropharyngeal pain, Palpitations, Vision blurred, Visual impairment
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), 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; Hypermobility syndrome, Hypermobilitet
Preexisting Conditions:
Diagnostic Lab Data: Carried out studies and / or laboratory tests: No
CDC Split Type: WAES1605DNK002395

Write-up: Information has been received from Sanofi Pasteur MSD (manufacturer control number # 2016004929) as part of business agreement on 04-MAY-2016. Case received from a HCP via Health Authority on 02-MAY-2016 with the reference number DK-DKMA-WBS-0003335. Case from a physician. A 14-year-old female adolescent patient received GARDASIL, (batch number LOT NOT REP, Dose 1) via intramuscular route on 04-Jul-2008, GARDASIL, (batch number unknown, Dose 2) on 04-Feb-2009, GARDASIL, (batch number unknown, Dose 3) on 02-Jul-2009. The patient experienced Arthralgia in OCT-2009, back pain in OCT-2009, fasciculation skeletal muscle in 2010, discomfort bodily, most legs in 2011, influenza symptoms of joint pain/cramps in 2010, infection tendency in 2010, tiredness in 2010, headache in 2012, visual disturbance, difficulty focusing in 2012, orthostatic dizziness in 2012, concentration difficulty in 2012, throat pain in 2010, abdominal pain in 2011, nausea in 2011, palpitations in 2012, influenza symptoms of joint pain / cramps in 2010, difficulty concentrating in 2012 and could not complete high school, is on education aid on an unknown date. The patient had a medical history of Hypermobility syndrome. The patient''s outcome was reported as not recovered/not resolved. History around adverse reaction: Could not complete high school, is on education aid. Other vaccines: No. Other medicines: Yes.

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