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This is VAERS ID 636432

History of Changes from the VAERS Wayback Machine

First Appeared on 10/14/2016

636432
VAERS Form:
Age:13.0
Gender:Female
Location:Foreign
Vaccinated:2012-09-10
Onset:2013-01-01
Submitted:2016-05-20
Entered:2016-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H008041 / - UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Anxiety, Asthenia, Chronic fatigue syndrome, Depression, Disturbance in attention, Dyspnoea, Feeling abnormal, Headache, Irritability, Somnolence, Body temperature fluctuation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Immunisation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1605GBR008314

Write-up:Information has been received from Sanofi Pasteur MSD (MFR control number GB-1577272925-2016005293) on 19-MAY-2016. This case was received from MHRA (Ref no. GB-MHRA-ADR 23470139, GB-MHRA-EYC 00139455) on 16-MAY-2016. Initial case received from a consumer/other non-health professional concerns a 13-year-old female adolescent patient received human papillomavirus vaccine (manufacturer unknown, batch/lot number H009041; expiration date: 31-JAN-2015) via parenteral route on 10-SEP-2012, human papillomavirus vaccine (manufacturer unknown, batch number H013055) via parenteral route on 25-Mar-2013, human papillomavirus vaccine (manufacturer unknown, batch number H010590; Expiration date: 28-FEB-2015) via parenteral route on an unknown date. Medical history: None provided; Concomitant medications: None provided; the patient experienced chronic fatigue syndrome on 01-JAN-2013, anxiety, asthenia, feeling abnormal, headache, depression, disturbance in attention, irritability, dyspnea, body temperature fluctuation and somnolence on an unknown date. the patient''s outcome was reported as Not Recovered/Not Resolved.


Changed on 9/14/2017

636432 Before After
VAERS Form:(blank) 1
Age:13.0
Gender:Female
Location:Foreign
Vaccinated:2012-09-10
Onset:2013-01-01
Submitted:2016-05-20
Entered:2016-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H008041 / - UNK UN / UN

Administered by: Other      Purchased by: Other
Symptoms: Anxiety, Asthenia, Chronic fatigue syndrome, Depression, Disturbance in attention, Dyspnoea, Feeling abnormal, Headache, Irritability, Somnolence, Body temperature fluctuation

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Immunisation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': WAES1605GBR008314

Write-up:Information has been received from Sanofi Pasteur MSD (MFR control number GB-1577272925-2016005293) on 19-MAY-2016. This case was received from MHRA (Ref no. GB-MHRA-ADR 23470139, GB-MHRA-EYC 00139455) on 16-MAY-2016. Initial case received from a consumer/other non-health professional concerns a 13-year-old female adolescent patient received human papillomavirus vaccine (manufacturer unknown, batch/lot number H009041; expiration date: 31-JAN-2015) via parenteral route on 10-SEP-2012, human papillomavirus vaccine (manufacturer unknown, batch number H013055) via parenteral route on 25-Mar-2013, human papillomavirus vaccine (manufacturer unknown, batch number H010590; Expiration date: 28-FEB-2015) via parenteral route on an unknown date. Medical history: None provided; Concomitant medications: None provided; the patient experienced chronic fatigue syndrome on 01-JAN-2013, anxiety, asthenia, feeling abnormal, headache, depression, disturbance in attention, irritability, dyspnea, body temperature fluctuation and somnolence on an unknown date. the patient''s outcome was reported as Not Recovered/Not Resolved.


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