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This is VAERS ID 674987

Case Details

VAERS ID: 674987 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2016-12-27
Entered: 2016-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Unknown
Symptoms: Appendicitis perforated, Complex regional pain syndrome, Fatigue, Headache, Postural orthostatic tachycardia syndrome, Tachycardia, Weight bearing difficulty
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal perforation (narrow)

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GB0095075131612GBR013259

Write-up: This spontaneous report was received from a consumer via the Agency (case report number GB-MHRA-EYC 00150652) referring to a 12 year old female patient. On an unspecified date in 2011, the patient was vaccinated with unknown dose number of GARDASIL, 3 DF, parenteral. On an unspecified date in 2011, the patient experienced burst appendix, complex regional pain syndrome, postural orthostatic tachycardia syndrome (POTS) symptoms, tachycardia, headache, chronic fatigue and unable to weight bear on either leg. The outcome of complex regional pain syndrome, weight bearing difficulty, tachycardia, appendicitis perforated, fatigue and headache was reported as not recovered. The relationship between adverse events and therapy was not provided. Additional information is not expected as no follow up can be obtained from the Agency.


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