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This is VAERS ID 643136

Case Details

VAERS ID: 643136 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
Vaccinated:2009-05-06
Onset:0000-00-00
Submitted: 2016-06-15
Entered: 2016-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Activities of daily living impaired, Dizziness, Fatigue, Headache, Laboratory test, Neck pain, Neurological examination, Tension headache
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Vestibular disorders (broad), Arthritis (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, Schooling compromised for several years. Currently in the process of HF (Higher Preparatory Examination), but with difficulty; Immunisation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Have studies and/or laboratory tests been carried out: Yes; Examined at pediatrician, neurologist, headache clinic/tension headaches/.
CDC Split Type: WAES1606DNK006797

Write-up: Information has been received from Sanofi Pasteur MSD (SPM) MFR Control number DK-1577272925-2016006150) on 14-JUN-2016. Case received from a physician via HA on 09-Jun-2016 with reference numbers DK-DKMA-WBS-0003710 / DK-DKMA-ADR 23517077. A 12-year-old female adolescent patient received GARDASIL, (batch/lot number lot not rep, Dose 1) via intramuscular route on 04-Mar-2009, GARDASIL, (batch/lot number Lot Not Rep, Dose 2) on 06-May-2009, GARDASIL, (batch/lot number Lot Not Rep, Dose 3) on 03-Sep-2009. The patient received concomitant administration of PRIORIX 1DF on 04-Mar-2009. The patient experienced dizziness, tiredness, neck pain, schooling compromised for several years. Currently in the process of HF (Higher Preparatory Examination), but with difficulty and tension headache/headache on an unknown date. The patient''s outcome was reported as not recovered/not resolved for all AE. History Around side effect: Vaccination in 2009. Since increasingly tired, dizzy, headaches and neck pain. Is examined by a pediatrician, neurologist and headache clinic/ tension headaches/.


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