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This is VAERS ID 675257

Case Details

VAERS ID: 675257 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2016-12-28
Entered: 2016-12-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Unknown
Symptoms: Amnesia, Depression, Muscular weakness, Pain, Post viral fatigue syndrome
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (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: Acetaminophen (+) codeine phosphate; ibuprofen lysine; pizotyline
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: GB0095075131612GBR012907

Write-up: Information has been received from a consumer via agency (HA# GB-MHRA-EYC 00150655) concerning a 12 year old male patient. The concurrent condition and medical history were not reported. Concomitant therapies included acetaminophen (+) codeine phosphate, ibuprofen lysine and pizotyline. On an unknown date, the patient was vaccinated with a dose of human papillomavirus vaccine (manufacturer unknown) (lot#, expiry date, strength and dose were unspecified) parenterally for prophylaxis. On unknown dates, the patient had experienced myalgic encephalomyelitis, chronic pain, memory loss, muscle weakness and depression. It was reported that the patient should not have been dispensed in school. The advices of lots of specialist had been sought. The outcome of those events was not resolved. The causality assessment between the unspecified therapy (Active Drug substance name: human papilloma virus) and events was not provided. The events were considered to be disabling and medically significant.


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