National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 643861

History of Changes from the VAERS Wayback Machine

First Appeared on 10/14/2016

643861
VAERS Form:
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. - / - UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Abdominal pain, Arthralgia, Asthma, Dysuria, Fatigue, Gastrooesophageal reflux disease, Headache, Insomnia, Muscular weakness, Palpitations, Pityriasis rosea, Sjogren's syndrome, Urticaria, Activities of daily living impaired, Temperature regulation disorder, Immunodeficiency, Tilt table test normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) 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.


Changed on 9/14/2017

643861 Before After
VAERS Form:(blank) 1
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, Arthralgia, Asthma, Dysuria, Fatigue, Gastrooesophageal reflux disease, Headache, Insomnia, Muscular weakness, Palpitations, Pityriasis rosea, Sjogren's syndrome, Urticaria, Activities of daily living impaired, Temperature regulation disorder, Immunodeficiency, Tilt table test normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) 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.


New Search

Link To This Search Result:

http://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=643861&WAYBACKHISTORY=ON


Copyright © 2017 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166