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This is VAERS ID 643734

Case Details

VAERS ID: 643734 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Foreign  
Submitted: 2016-06-23
Entered: 2016-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Abdominal distension, Cognitive disorder, Constipation, Dyskinesia, Dysmenorrhoea, Fatigue, Headache, Loss of personal independence in daily activities, Muscular weakness, Nausea, Orthostatic intolerance, Tilt table test normal, Vision blurred
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dyskinesia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (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 papillomavirus immunisation
Preexisting Conditions:
Diagnostic Lab Data: Has examinations and/or laboratory tests been conducted: According to tilt table test the patient does not fulfill diagnostic criteria for POTS.
CDC Split Type: WAES1606DNK010884

Write-up: Information has been received from Sanofi Pasteur MSD (SPM) (MFR control number DK-1577272925-2016006420) on 22-JUN-2016. Case received from a physician via HA on 17-JUN-2016 under the references DK-DKMA-WBS-0003778 / DK-DKMA-ADR 23525691. A 12-year-old female adolescent patient received GARDASIL (batch number lot unk, Dose 1) via intramuscular route on 11-FEB-2009, GARDASIL (batch number lot unk, Dose 2) via intramuscular route on 06-MAY-2009, GARDASIL (batch number lot unk, Dose 3) via intramuscular route on 30-SEP-2009. The patient experienced fatigue extreme, headache, orthostatic intolerance, nausea, feeling bloated, menses pain aggravated, cognitive dysfunction, involuntary muscle movement, limb weakness in both arms, obstipation, blurred vision, could not bike to school in periods and a lot of absence from continuation school and in high school on an unknown date. The process of the adverse events: After the third vaccination within the year of 2009 the patient experiences a noticeable fatigue and cognitive dysfunction. Subsequently the other reported symptoms occurs. The patient informs that she has a lot of absence from continuation school and in high school. Could not bike to school in periods. Earlier the patient has been a moderately active girl and has been dancing amongst other things. According to tilt table test the patient does not fulfill diagnostic criteria for POTS. Other vaccines: No. Other medication: No. The patient''s outcome was reported as not recovered/not resolved.

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