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This is VAERS ID 675039

Case Details

VAERS ID: 675039 (history)  
Age: 13.0  
Gender: Female  
Location: Foreign  
Vaccinated:2014-11-11
Onset:2014-11-19
   Days after vaccination:8
Submitted: 2016-10-18
   Days after onset:698
Entered: 2016-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. K002758 / - UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Complex regional pain syndrome
SMQs:

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
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:
Diagnostic Lab Data:
CDC Split Type: WAES1610GBR008283

Write-up: Information has been received from a physician via the agency (agency # GB-MHRA-ADR 23677507) referring to a 13 year old female patient. The patient''s medical history, concurrent condition and concomitant medication were unknown. On 11-NOV-2014 the patient was vaccinated with quadrivalent human papillomavirus (types 6, 11, 16, 18) recomb. Vaccine (manufacturer unknown) (batch/lot # K002758, expiration date and dose were unknown, intramuscular). On 19-NOV-2014, the patient experienced suspected complex regional pain syndrome. On an unknown date, the patient was admitted to hospital following numerous investigations. The patient was diagnosed with complex regional pain syndrome. At the time of reporting, the event persisted while limb was improving. Causality was not reported. The agency considered the event to be disabling and medically significant.


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