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This is VAERS ID 673794

Case Details

VAERS ID: 673794 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
Vaccinated:2013-05-15
Onset:0000-00-00
Submitted: 2016-09-16
Entered: 2016-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 3 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Arthritis, Disturbance in attention, Fatigue, Haematology test normal, Laboratory test normal, Liver function test normal, Mental disorder, Tension headache
SMQs:, Systemic lupus erythematosus (broad), Dementia (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (broad), Arthritis (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Human papilloma virus immunisation; Seizure; Stress
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Examinations or lab samples: Hepatic, infection and hematological samples, celiaki screening, vitamin D. All without remark
CDC Split Type: WAES1609DNK007741

Write-up: Information has been received from SPMSD (manufacturer control no. DK-1577272925-2016009200) on 15-SEP-2016. Case received from a physician via Health Authority on 12-Sep-2016 under reference no DK-DKMA-WBS-0004422 / DK-DKMA-ADR 23638549. A 12-year-old female adolescent patient received GARDASIL (batch number Not available, Dose 1) via intramuscular route on 18-Sep-2012, GARDASIL (batch number Not available, Dose 2) via intramuscular route on 21-Nov-2012, GARDASIL, (batch number Not available, Dose 3) via intramuscular route on 15-May-2013. The patient experienced Headache tension, Fatigue, Attention impaired and Coxitis on an unknown date. Description: The patient has a number of diffuse symptoms. The temporal relation to GARDASIL vaccination is uncertain. Before and prior to the symptoms, there were significant psychosocial issues which more likely explains the events. Other Vaccines: No. Other Medicines: No. The patient''s outcome was reported as Not Recovered/Not Resolved for Headache tension and Attention impaired. The patient''s outcome was reported as Recovering/Resolving for Fatigue and Coxitis.


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