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This is VAERS ID 673958

Case Details

VAERS ID: 673958 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
Vaccinated:2014-08-22
Onset:2014-09-01
   Days after vaccination:10
Submitted: 2016-09-19
   Days after onset:749
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: Activities of daily living impaired, Dizziness, Fatigue, Headache, Hyperhidrosis, Influenza like illness, Malaise, Nasopharyngitis, Nausea, Pyrexia, Sleep disorder, Tilt table test normal, Vision blurred, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Human papilloma virus immunisation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Examinations or lab samples: The tilt table test showed that she did not fulfill the diagnostic criteria for Postural Orthostatic Tachycardia Syndrome.
CDC Split Type: WAES1609DNK008827

Write-up: Information has been received from Sanofi Pasteur MSD (SPM) (MFR Control No: DK-1577272925-2016009186) on 16-SEP-2016. Case received from a physician via Health Authority on 12-SEP-2016 under reference numbers DK-DKMA-WBS-0004448 / DK-DKMA-ADR 23637823. A 12-year-old female adolescent patient received GARDASIL (batch number Not available, Dose 1) via intramuscular route on 23-Dec-2013, GARDASIL (batch number Not available, Dose 2) via intramuscular route on 07-Mar-2014, GARDASIL (batch number Not available, Dose 3) via intramuscular route on 22-Aug-2014. The patient experienced Flu like symptoms, Headache, Dizziness, Sleep disorder, Fatigue/tiredness, Sweating increased, Difficulty focusing eyes, Malaise, Common cold, Fever, Nausea, Vomiting and On sick leave for 1 month on an unknown date. The patient was admitted to hospital on an unspecified date. The patient reports that her symptoms started about 3 weeks after the third vaccination - with malaise, common cold, fever, fatigue, nausea, vomiting and dizziness. This lasted about 1/2 years. The remaining symptoms followed afterwards. When she got vaccinations she played handball 4 times weekly and games at the weekends, and went to a sports program at school. As a consequence of her symptoms the patient was on sick leave for 1 month, but now she is back at school. Other vaccines: unknown. Other medicines: unknown. The patient recovered from Flu like symptoms in MAR-2015, Dizziness in MAR-2015, Malaise in MAR-2015, Common cold in MAR-2015, Fever in MAR-2015, Nausea in MAR-2015, Vomiting in MAR-2015 and sick leave for 1 month on an unknown date. The patient had not recovered from Sleep disorder, Difficulty focusing eyes, Sweating increased, Fatigue/tiredness. The patient was recovering from Headache.


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