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This is VAERS ID 669902

History of Changes from the VAERS Wayback Machine

First Appeared on 4/14/2017

669902
VAERS Form:
Age:15.0
Gender:Female
Location:Foreign
Vaccinated:2014-03-01
Onset:2014-03-01
Submitted:2016-12-06
Entered:2016-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - RA / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 RA / UN

Administered by: Other      Purchased by: Unknown
Symptoms: Anxiety, Blood growth hormone abnormal, Blood thyroid stimulating hormone abnormal, Chronic fatigue syndrome, Cow's milk intolerance, Dizziness, Dyspepsia, Encephalopathy, Headache, Hypotension, Lactose intolerance, Menstrual disorder, Multi-vitamin deficiency, Muscle spasms, Nausea, Seizure, Mineral deficiency, Postural orthostatic tachycardia syndrome

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: CLENIL MODULITE; FLUOXETIN; VENTOLIN (albuterol)
Current Illness: Asthma; Prophylactic vaccination
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GB0095075131612GBR002322

Write-up:Information has been received from Sanofi Pasteur MSD (SPM) (MFR control number # GB-1577272925-2016012448) on 05-DEC-2016. This report was received from the regulatory authority on 01-DEC-2016 under reference number GB-MHRA-ADR 23310013. Case received from a consumer/other non health professional concerning a 15-year-old female adolescent patient (weight: 53.52kg) who received (Gardasil, batch number unknown) via parenteral route in October 2013, (Gardasil, batch number unknown) via parenteral route on an unknown date and (Gardasil, batch number unknown) via parenteral route in March 2014. The patient just had flu injection in the right arm and so was given human papilloma virus vaccine in the same arm. The patient was told that she should never had the two together. Current conditions included asthma. The patient received concomitant administration of Clenil Modulite, Fluoxetin and Ventolin on an unknown date. The patient experienced chronic headaches, dizziness, chronic fatigue syndrome, muscle spasms, blood thyroid stimulating hormone abnormal, nausea, blood growth hormone abnormal, digestion impaired, multi-vitamin deficiency, mineral deficiency in March 2014, anxiety, low blood pressure in September 2014, dairy intolerance in February 2015, non-epileptic seizure in September 2015 and menstrual disorder on an unknown date. The mother wants to investigation for postural tachycardia syndrome and myalgic encephalopathy as her daughter shows side effects of both. The patient visited general practitioner several times who referred her to paediatrician who diagnosed lactose then dairy intolerance, then referred to child mental health services and currently children and young person service who prescribed medication and counselling. She now can''t eat lactose or dairy at all. Additional investigations included blood pressure measurement (low), blood growth hormone (abnormal) and blood thyroid stimulating hormone (abnormal) on an unknown date. The event chronic headaches, dizziness, chronic fatigue syndrome, muscle spasms, non-epileptic seizure, dairy intolerance, low blood pressure, digestion impaired, multi-vitamin deficiency, mineral deficiency were not recovered/not resolved, blood thyroid stimulating hormone abnormal, blood growth hormone abnormal, nausea were recovering/resolving, anxiety recovered with sequelae and the outcome of menstrual disorder was unknown. The patient''s overall outcome was reported as not recovered/not resolved.


Changed on 9/14/2017

669902 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:Foreign
Vaccinated:2014-03-01
Onset:2014-03-01
Submitted:2016-12-06
Entered:2016-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK RA / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 3 RA / UN

Administered by: Other      Purchased by: Unknown
Symptoms: Anxiety, Blood growth hormone abnormal, Blood thyroid stimulating hormone abnormal, Chronic fatigue syndrome, Cow's milk intolerance, Dizziness, Dyspepsia, Encephalopathy, Headache, Hypotension, Lactose intolerance, Menstrual disorder, Multi-vitamin deficiency, Muscle spasms, Nausea, Seizure, Mineral deficiency, Postural orthostatic tachycardia syndrome

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: CLENIL MODULITE; FLUOXETIN; VENTOLIN (albuterol)
Current Illness: Asthma; Prophylactic vaccination
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GB0095075131612GBR002322

Write-up:Information has been received from Sanofi Pasteur MSD (SPM) (MFR control number # GB-1577272925-2016012448) on 05-DEC-2016. This report was received from the regulatory authority on 01-DEC-2016 under reference number GB-MHRA-ADR 23310013. Case received from a consumer/other non health professional concerning a 15-year-old female adolescent patient (weight: 53.52kg) who received (Gardasil, batch number unknown) via parenteral route in October 2013, (Gardasil, batch number unknown) via parenteral route on an unknown date and (Gardasil, batch number unknown) via parenteral route in March 2014. The patient just had flu injection in the right arm and so was given human papilloma virus vaccine in the same arm. The patient was told that she should never had the two together. Current conditions included asthma. The patient received concomitant administration of Clenil Modulite, Fluoxetin and Ventolin on an unknown date. The patient experienced chronic headaches, dizziness, chronic fatigue syndrome, muscle spasms, blood thyroid stimulating hormone abnormal, nausea, blood growth hormone abnormal, digestion impaired, multi-vitamin deficiency, mineral deficiency in March 2014, anxiety, low blood pressure in September 2014, dairy intolerance in February 2015, non-epileptic seizure in September 2015 and menstrual disorder on an unknown date. The mother wants to investigation for postural tachycardia syndrome and myalgic encephalopathy as her daughter shows side effects of both. The patient visited general practitioner several times who referred her to paediatrician who diagnosed lactose then dairy intolerance, then referred to child mental health services and currently children and young person service who prescribed medication and counselling. She now can''t eat lactose or dairy at all. Additional investigations included blood pressure measurement (low), blood growth hormone (abnormal) and blood thyroid stimulating hormone (abnormal) on an unknown date. The event chronic headaches, dizziness, chronic fatigue syndrome, muscle spasms, non-epileptic seizure, dairy intolerance, low blood pressure, digestion impaired, multi-vitamin deficiency, mineral deficiency were not recovered/not resolved, blood thyroid stimulating hormone abnormal, blood growth hormone abnormal, nausea were recovering/resolving, anxiety recovered with sequelae and the outcome of menstrual disorder was unknown. The patient''s overall outcome was reported as not recovered/not resolved.


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