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This is VAERS ID 643861

Case Details

VAERS ID: 643861 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
Vaccinated:2011-11-10
Onset:0000-00-00
Submitted: 2016-06-27
Entered: 2016-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Activities of daily living impaired, Arthralgia, Asthma, Dysuria, Fatigue, Gastrooesophageal reflux disease, Headache, Immunodeficiency, Insomnia, Muscular weakness, Palpitations, Pityriasis rosea, Sjogren's syndrome, Temperature regulation disorder, Tilt table test normal, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Asthma/bronchospasm (narrow), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Lacrimal disorders (narrow), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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 papillomavirus immunisation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Examinations and/or laboratory tests: unknown; Tilt table test, does not fulfill POTS criteria
CDC Split Type: WAES1606DNK012349

Write-up: Information has been received from Sanofi Pasteur MSD (MFR control number DK-1577272925-2016006524) on 24-JUN-2016. Case received from a physician via HA on 21-JUN-2016 under reference DK-DKMA-ADR 23529268. A 12-year-old female adolescent patient received GARDASIL (batch number lot unk) via intramuscular route on 10-NOV-2011, GARDASIL (batch number lot unk) via intramuscular route on 08-FEB-2012. The patient experienced Hives, Asthma, Sjoegren''s syndrome, Pityriasis rosea, Headache, Palpitation, Acid reflux (oesophageal), Abdominal pain, Voiding difficulty, Fatigue, Sleep difficult, Weakness of limbs, Immunocompromised, Temperature regulation disorder, Wrist pain, Quit playing football completely and A lot of absence, has a hard time in school on an unknown date. Process around the adverse event: Patient informs about symptom onset after the first vaccination. She experiences hives, is diagnosed with asthma, Sjogren''s syndrome and pityriasis rosea. Subsequently the other symptoms occurs. Up until the vaccinations the patient played football 6 times a week of 1.5 hours a time. As a consequence of her symptoms the patient has quit football completely, she has a hard time in school since everything requires more energy of her. She has also a lot of absence from school e.g. due to hospital examinations/checkups that she has to go to. Other vaccines: unknown. Tilt table test shows that she does not fulfill diagnostic criteria for Postural Orthostatic Tachycardia Syndrome. The patient was admitted to hospital on an unspecified date. The patient''s out was reported as Not Recovered/Not Resolved.


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