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This is VAERS ID 673955

Case Details

VAERS ID: 673955 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
Vaccinated:2011-02-02
Onset:0000-00-00
Submitted: 2016-09-19
Entered: 2016-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 3 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Abdominal pain, Activities of daily living impaired, Appetite disorder, Arthralgia, Cognitive disorder, Cystitis, Dizziness postural, Dyskinesia, Fatigue, Hyperhidrosis, Joint swelling, Muscular weakness, Myalgia, Palpitations, Photophobia, Skin disorder, Sleep disorder, Somnolence, Syncope, Tilt table test normal
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Dyskinesia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Cardiomyopathy (broad), Corneal disorders (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Human papilloma virus immunisation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Examinations or lab samples: Tilt table test performed at the clinic showed that the patient did not fulfill the diagnostic criteria for POTS.
CDC Split Type: WAES1609DNK007508

Write-up: Information has been received from a physician via SPMSD (case report number DK-1577272925-2016009192) on 15-SEP-2016. Case received from a physician via Health Authority on 12-Sep-2016 under reference no DK-DKMA-WBS-0004430 / DK-DKMA-ADR 23635780. A 14-year-old female adolescent patient received GARDASIL (batch number Not available, Dose 1) via intramuscular route on 03-Aug-2010, GARDASIL (batch number Not available, Dose 2) via intramuscular route on 06-Oct-2010, GARDASIL (batch number Not available, Dose 3) via intramuscular route on 02-Feb-2011. The patient experienced Lipothymia recurrent, Joint pain, Muscle pain, Cognitive dysfunction, Dizziness on standing up, Palpitations during activity, Abdominal pain, Cystitis, Skin problems, sleeping disorder, Fatigue extreme, Involuntary muscle movement, Limb weakness, Abnormal sweating, Appetite, Light sensitivity to eyes, Knee and ankle joint swollen, Large absence from high school and Feels socially limited / difficult to grasp the social life on an unknown date. The patient reported that she experiencing unannounced lipothymia after the third vaccination. She was on a trip with the youth school when her roommates suddenly could not wake her up. Have had recurrent incidences. Then the other reported symptoms followed. Tilt table test performed at the clinic showed that the patient did not fulfill the diagnostic criteria for POTS. The patient reported that before the vaccination she competed in swimming at a high level. The patient feels limited today socially and dares not swim with her friends and find it difficult to grasp the social life, also because of her fatigue. Been absent a lot from middle school and high school (1. grade and 2. grade) but was just with the "absence limit". Other Vaccines: Do not know. Other Medicines: Do not know. The patient''s outcome was reported as Not Recovered/Not Resolved for Lipothymia recurrent and Feels socially limited / difficult to grasp the social life. The patient''s outcome was reported as Unknown for Joint pain, Muscle pain, Cognitive dysfunction, Dizziness on standing up, Palpitations during activity, Abdominal pain, Cystitis, Skin problems, sleeping disorder, Fatigue extreme, Involuntary muscle movement, Limb weakness, Abnormal sweating, Appetite, Light sensitivity to eyes, Knee and ankle joints swollen and large absence from high school.


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