National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 675218

Case Details

VAERS ID: 675218 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
Submitted: 2016-10-21
Entered: 2016-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Activities of daily living impaired, Blood test normal, Computerised tomogram head normal, Disturbance in attention, Electroencephalogram abnormal, Fatigue, Headache, Hyperacusis, Muscle twitching, Nuclear magnetic resonance imaging brain normal, Nuclear magnetic resonance imaging spinal normal, Peripheral coldness, Presyncope, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Dyskinesia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (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: Immunisation; 2012, Migraine; 2009, Depression, symptoms of depression since 2009; 2009, Headache; 2011, Head injury, occipital injury, daily headache since 2011; 2009, Anxiety
Preexisting Conditions: 2009, Osteomyelitis, osteomyelitis/sepsis left hip
Diagnostic Lab Data: Computerised Tomogram Head on 14-Sep-2016: Normal; Blood test on 14-SEP-2016: Normal; Nuclear magnetic resonance imaging brain on 14-SEP-2016: Normal; Nuclear magnetic resonance imaging (cervical spine) on 14-SEP-2016: Normal; Electroencephalogram on 14-SEP-2016: Results = not epilepsy, possible drug influence
CDC Split Type: WAES1610NOR011122

Write-up: Information has been received from Sanofi Pasteur MSD (manufacturer control # NO-1577272925-2016010439) on 20-OCT-2016. Case received from a physician via agency (authority # NO-NOMAADVRE-FHI-2016-22690) on 14-Oct-2016. A 11-year-old female child patient received GARDASIL (lot/batch number lot not rep, Dose 1) via parenteral route on 01-Oct-2010, GARDASIL (lot/batch not rep, Dose 2) on 10-Dec-2010, GARDASIL (lot/batch number lot not rep, Dose 3) on 10-Jun-2011. The patient experienced Concentration impaired, Exhaustion since 2009, worsening 2010, Headache since 2009, worsening 2010, Hyperacusis, Sleepiness since 2009, worsening 2010, Tiredness since 2009, worsening 2010, Cold feet, Twitching spontaneously and when touched, and Near syncope when getting up abruptly on an unknown date. The patient had a medical history of: Migraine in 2012; Depression in 2009; Headache in 2009; Osteomyelitis in 2009; Head injury in 2011; Anxiety in 2009. Treatment: Venlafaxin since 2014 and TELFAST as required School attendance decreased. This is a preliminary report. A full evaluation is being undertaken. Additional investigations included: Computerised Tomogram Head on 14-Sep-2016: normal; Blood test on 14-Sep-2016: normal; Nuclear magnetic resonance imaging brain on 14-Sep-2016: normal; Nuclear magnetic resonance imaging (cervical spine) on 14-Sep-2016: normal; Electroencephalogram on 14-Sep-2016: results = not epilepsy, possible drug influence. The patient''s outcome was reported as Not Recovered/Not Resolved.

New Search

Link To This Search Result:

Copyright © 2018 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166