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This is VAERS ID 643923

History of Changes from the VAERS Wayback Machine

First Appeared on 10/14/2016

643923
VAERS Form:
Age:13.0
Gender:Female
Location:Foreign
Vaccinated:2013-06-01
Onset:0000-00-00
Submitted:2016-06-29
Entered:2016-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Fatigue, Nausea, Tension headache, Activities of daily living impaired, Laboratory test

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: Human papilloma virus
Preexisting Conditions: Fatigue, headache and fatigue while ling and complicated process with orthodontic treatment, which is believed to have contributed to the symptoms; Headache, headache and fatigue while ling and complicated process with orthodontic treatment, which is believed to have contributed to the symptoms
Allergies:
Diagnostic Lab Data: Carried out studies and / or laboratory tests: Yes; Investigated at infectious diseases and ENT departments; No treatment needed; Have just started physiotherapy with good effect.
CDC 'Split Type': WAES1606DNK013745

Write-up:Information has been received from Sanofi Pasteur MSD (SPM) (MFR control number DK-1577272925-2016006649) on 28-JUN-2016. Case received from a physician via HA on 23-JUN-2016 with reference number DK-DKMA-WBS-0003849. A 12-year-old female adolescent patient received GARDASIL, (batch number Lot UNK, Dose 1) via intramuscular route in November 2012, GARDASIL, (batch number lot UNK, Dose 2) via intramuscular route in February 2013, GARDASIL, (batch number Lot UNK, Dose 3) via intramuscular route in June 2013. Adverse Reaction: The patient experienced Tension-type headache, Nausea, Fatigue and 20% school attendance on an unknown date. The patient had a medical history of: -Headache, -Fatigue. History Around the Adverse Events: Disability in the form of 20% school attendance. Other vaccine: No. Other medicine: No. The patient''s outcome was reported as not recovered/not resolved.


Changed on 9/14/2017

643923 Before After
VAERS Form:(blank) 1
Age:13.0
Gender:Female
Location:Foreign
Vaccinated:2013-06-01
Onset:0000-00-00
Submitted:2016-06-29
Entered:2016-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 3 UN / IM

Administered by: Other      Purchased by: Other
Symptoms: Fatigue, Nausea, Tension headache, Activities of daily living impaired, Laboratory test

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: Human papilloma virus
Preexisting Conditions: Fatigue, headache and fatigue while ling and complicated process with orthodontic treatment, which is believed to have contributed to the symptoms; Headache, headache and fatigue while ling and complicated process with orthodontic treatment, which is believed to have contributed to the symptoms
Allergies:
Diagnostic Lab Data: Carried out studies and / or laboratory tests: Yes; Investigated at infectious diseases and ENT departments; No treatment needed; Have just started physiotherapy with good effect.
CDC 'Split Type': WAES1606DNK013745

Write-up:Information has been received from Sanofi Pasteur MSD (SPM) (MFR control number DK-1577272925-2016006649) on 28-JUN-2016. Case received from a physician via HA on 23-JUN-2016 with reference number DK-DKMA-WBS-0003849. A 12-year-old female adolescent patient received GARDASIL, (batch number Lot UNK, Dose 1) via intramuscular route in November 2012, GARDASIL, (batch number lot UNK, Dose 2) via intramuscular route in February 2013, GARDASIL, (batch number Lot UNK, Dose 3) via intramuscular route in June 2013. Adverse Reaction: The patient experienced Tension-type headache, Nausea, Fatigue and 20% school attendance on an unknown date. The patient had a medical history of: -Headache, -Fatigue. History Around the Adverse Events: Disability in the form of 20% school attendance. Other vaccine: No. Other medicine: No. The patient''s outcome was reported as not recovered/not resolved.


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