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This is VAERS ID 636219

Case Details

VAERS ID: 636219 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Foreign  
Vaccinated:2015-01-13
Onset:2015-01-13
   Days after vaccination:0
Submitted: 2016-05-19
   Days after onset:491
Entered: 2016-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain upper, Anaemia, Back pain, Chest pain, Disturbance in attention, Fatigue, Headache, Hormone level abnormal, Laryngospasm, Nausea, Vitamin B12 deficiency
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (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: homeopathic medications (unspecified); nutritional supplements
Current Illness: Immunisation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1605GBR008647

Write-up: Information has been received from Sanofi Pasteur MSD (manufacturer control number 2016005264) as part of a business agreement on 17-MAY-2016. This case was received from the Regulatory Authority Agency on 13-MAY-2016 under reference number GB-MHRA-ADR 2348619. Case received from a consumer/other non health professional on 13-MAY-2016. A 13-year-old female adolescent patient received GARDASIL, (batch number unknown) via parenteral route on 13-Jan-2015. The patient received concomitant administration of: -Homeopathics NOS on an unknown date. -(Nutritional Supplement) on an unknown date. The patient experienced Anaemia vitamin B12 deficiency / chronic fatigue / poor concentration / headaches / back pain / nausea / stomach cramps / hormonal imbalance / larynx spasm / chest pain on 13-JAN-2015. The patient''s outcome was reported as not recovered/not resolved.


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