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This is VAERS ID 646130

Case Details

VAERS ID: 646130 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Foreign  
Vaccinated:2016-05-05
Onset:2016-05-12
   Days after vaccination:7
Submitted: 2016-07-28
   Days after onset:77
Entered: 2016-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. K010050 / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Bone pain, Chronic fatigue syndrome, Headache, Hepatic pain, Injection site pain, Loss of personal independence in daily activities, Memory impairment, Muscular weakness, Myalgia, Pain, Palpitations, Paraesthesia, Postural orthostatic tachycardia syndrome, Renal pain, Spinal pain, Visual impairment
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Osteonecrosis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (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, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Chelidonium extract; hawthorn; ibuprofen; MERCILON; acetaminophen, Benzylpenicillin
Current Illness: Immunisation; Human papilloma virus
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1607GBR011050

Write-up: Information has been received from Sanofi Pasteur MSD (manufacturer control number # 2016007569) as part of business agreement on 26-JUL-2016. This case was received from the RA on 21-Jul-2016 under reference numbers GB-MHRA-ADR 23560715/ GB-MHRA-EYC 00142401. Case received from a consumer/other non health professional on 21-Jul-2016. A 13-year-old female adolescent patient received GARDASIL (lot/batch number K010050) via parenteral route on 05-May-2016. The patient received concomitant administration of Chelidonium Extract on an unknown date, Hawthorn/01349301/) on a unknown date, ibuprofen on an unknown date, MERLICON on an unknown date, ''Milk thistle seed'' on an unknown date, Multivitamin/0097801/) on an unknown date, Paracetamol on an unknown date, Penicillin/00000901/) on an unknown date. On 12-May-2016, 7 days post administration, the patient experienced postural orthostatic tachycardia syndrome, visual disturbance, frontal headache, occipital headache, chronic fatigue syndrome, spleen pain, liver pain, kidney pain, pelvic bone pain, spinal pain, Injection site muscle pain, Forearm muscle pain, generalized muscle weakness, paraesthesia, trigger point pain, palpitations and memory impaired. The patient was unable to commit to normal day to day activities. The patient''s symptoms worsened daily and pain was increased to a point where she was admitted to hospital 3 nights. The patient''s outcome was reported as not recovered/not resolved. Postural orthostatic tachycardia syndrome; visual disturbance, frontal headache; occipital headache; chronic fatigue syndrome; spleen pain; liver pain; kidney pain; pelvic bone pain; spinal pain; injection site muscle pain; forearm muscle pain; generalized muscle weakness; paraesthesia; trigger point pain; palpitations and memory impaired. Unable to commit to normal day to day activities. Symptoms worsened daily. Pain increased to a point where she was admitted to hospital for 3 nights.


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