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This is VAERS ID 675329

Case Details

VAERS ID: 675329 (history)  
Form: Version 1.0  
Gender: Female  
Location: Foreign  
   Days after vaccination:0
Submitted: 2016-10-31
   Days after onset:952
Entered: 2016-10-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Bedridden, Epstein-Barr virus infection, Post viral fatigue syndrome
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (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: Baclofen; azithromycin; lansoprazole
Current Illness: Immunodeficiency common variable, variable immune deficiency; Immunisation
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1610GBR015251

Write-up: Information was received from Sanofi Pasteur (manufacturer control # 2016010903) as part of a business agreement on 28-OCT-2016. This case was received from the RA on 26-OCT-2016 under the reference number GB-MHRA-ADR 23693153. Case received from a consumer/other non health professional. A 15-year-old female adolescent patient received GARDASIL, (batch number unknown) via parenteral route on 24-MAR-2014, GARDAIL, (batch number unknown) via parenteral route on 28-JUL-2014. The patient received concomitant administration of: -Baclofen on an unknown date, -Azithromycin on an unknown date, -Lansoprazole on an unknown date. The patient was firstly bed ridden after second was told this was unusual (onset date 24-MAR-2014). She also experienced Epstein-Barre virus infection and post viral fatigue syndrome on an unknown date. The patient had a medical history of immunodeficiency common variable. The patient''s outcome was reported as Not Recovered/Not Resolved.

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