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This is VAERS ID 636125

Case Details

VAERS ID: 636125 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Foreign  
Submitted: 2016-05-16
Entered: 2016-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain lower, Alopecia, Arthralgia, Back pain, Blood test, Dizziness postural, Dyspnoea, Fatigue, Headache, Infection susceptibility increased, Laparoscopy, Mood swings, Muscle spasms, Muscular weakness, Myalgia, Photophobia, Pollakiuria, Sensory disturbance, Temperature regulation disorder, Tic, Ultrasound abdomen, Ultrasound scan
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (narrow), Retroperitoneal fibrosis (broad), Dementia (broad), Dyskinesia (broad), Dystonia (broad), 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), Cardiomyopathy (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Arthritis (broad), Tendinopathies and ligament disorders (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: Human papilloma virus immunisation
Preexisting Conditions:
Diagnostic Lab Data: Hospitalized with abdominal pain several times, laparoscopy and Ultrasonography abdomen, blood tests. Blood test, unknown; Laparoscopy, unknown; Ultrasound scan, unknown
CDC Split Type: WAES1605DNK005749

Write-up: Information has been received from Sanofi Pasteur MSD (SPM) (manufacturer control # DK-1577272925-2016005137) as part of business agreement on 11-MAY-2016. Case received from a physician on 09-MAY-2016 with reference number DK-DKMA-WBS-0003370/ADR 23460513. A 13-year-old female adolescent patient received GARDASIL (batch number lot not rep, Dose 1) via intramuscular route on 21-Oct-2008, GARDASIL (batch number lot not rep, Dose 2) via intramuscular route on 23-Dec-2008, GARDASIL (batch number lot not rep, Dose 3) via intramuscular route on 21-Apr-2009. The patient experienced Arthralgia in 2009, Myalgia in 2011, Back pain in 2009, Muscle tics in 2010, Muscle weakness in 2011, Sensory disturbances in the skin when touched in 2012, Dizziness, orthostatic in 2010, Shortness of breath at light load in 2012, Sweating in 2012, Increased susceptibility to infections in 2011, Hair loss in 2010, Lower abdominal pain in 2009, Tiredness in 2010, Headache in 2014, Light sensitivity in 2014, Nausea in 2008, Frequent urination in 2011, Mood swings in 2011, Muscle cramps in 2010, Changed temperature regulation in 2012, Complication with school and Commercial College student completed in 4 years instead of 3 years on an unknown date and Abdominal pain on an unknown date. History around side effect: Impedes School and Commercial College student out of 4 years instead of 3 years. Other Vaccines: No. Other Medicines: No. The patient was admitted to hospital on an unspecified date. The patient''s outcome was reported as Not Recovered/Not Resolved.

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