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This is VAERS ID 265766

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 265766
VAERS Form:
Age:19.0
Gender:Male
Location:California
Vaccinated:2006-08-04
Onset:2006-10-23
Submitted:2006-11-01
Entered:2006-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (MENOMUNE) / AVENTIS PASTEUR, INC. UE935AA / 0 UN / IM

Administered by: Private      Purchased by: Unknown
Symptoms: Asthenia, Blood pressure increased, Cardiomyopathy, Depression, Difficulty in walking

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 14     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Tetracycline
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Epstein Barr virus Antibodies all neg, CMV antibodies neg, Lyme disease antibody neg, D Dimer increase 3.68.
CDC 'Split Type':

Write-up:Developed difficulty walking 10/23/06. Admitted on 10/25/06 to ICU with rash, inability to lift legs off bed, bilateral arm weakness, headache, shortness of breath, neck weakness, voice affected, BP increase, tachycardic, Possible pulmonary emboli, gettin"g 7 days of IVIG.


Changed on 12/8/2009

VAERS ID: 265766 Before After
VAERS Form:
Age:19.0 18.0
Gender:Male
Location:California
Vaccinated:2006-08-04
Onset:2006-10-23
Submitted:2006-11-01
Entered:2006-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (MENOMUNE) / AVENTIS PASTEUR, INC. SANOFI PASTEUR UE935AA / 0 UN / IM

Administered by: Private      Purchased by: Unknown Private
Symptoms: Asthenia, Blood pressure increased, Cardiomyopathy, Depression, Difficulty in walking, Dysphagia, Dysphonia, Dyspnoea, Guillain-Barre syndrome, Headache, Hypokinesia, Laboratory test abnormal, Pulmonary embolism, Rash, Tachycardia, Thrombocytopenia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 14     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Tetracycline
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Epstein Barr virus Antibodies all neg, CMV antibodies neg, Lyme disease antibody neg, D Dimer increase 3.68. Labs: chem 11/2/06 protein 8.4, albumin 5.2, calcium 10.6, alk phos 130, CBC 11/2/06-auto lymph 18.4, auto mono 11.6, auto granul
CDC 'Split Type':

Write-up:Developed difficulty walking 10/23/06. Admitted on 10/25/06 to ICU with rash, inability to lift legs off bed, bilateral arm weakness, headache, shortness of breath, neck weakness, voice affected, BP increase, tachycardic, Possible pulmonary emboli, gettin"g getting 7 days of IVIG. 11/8/06-neurology consultation of 10/25/06: DX severe GBS with rapid ascending weakness of all four limbs and currently he has moderate cervical neck weakness and mild shortness of breath. 12/27/06-DC Summary received and reviewed for DOS 10/25-11/09/06 DC DX: Guillain Barre Syndrome Dysphagia, improving Possible depression possible heparin induced thrombocytopenia Sinus tachycardia history sinus pause on 10/28/06. RX with 5 day course IVIG with no improvement then RX with additional 2 days for total of 7 days.DC transferred to rehab facility.


Changed on 5/14/2017

VAERS ID: 265766 Before After
VAERS Form:
Age:18.0
Gender:Male
Location:California
Vaccinated:2006-08-04
Onset:2006-10-23
Submitted:2006-11-01
Entered:2006-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR UE935AA / 0 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Blood pressure increased, Cardiomyopathy, Depression, Difficulty in walking, Dysphagia, Dysphonia, Dyspnoea, Guillain-Barre syndrome, Headache, Hypokinesia, Laboratory test abnormal, Pulmonary embolism, Rash, Tachycardia, Thrombocytopenia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 14     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Tetracycline
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Epstein Barr virus Antibodies all neg, CMV antibodies neg, Lyme disease antibody neg, D Dimer increase 3.68. Labs: chem 11/2/06 protein 8.4, albumin 5.2, calcium 10.6, alk phos 130, CBC 11/2/06-auto lymph 18.4, auto mono 11.6, auto granul granulocyte 82.8, EBV WNL, Cytomegalovirus AB 0.40, parathyroid hormone 41, lyme disease antibody 0.70, lead 1.8, CPI isoenzyme 56, D-Dimer 3.68, EKG: left atrial abnormality, early repolarization, MRI thoracic spine: multilevel degenerative disease MRI brain: no evidence for intracerebral mass, shift or bleed. Small fluid collection within right petrous apex which probably represents a small petrus apes effusion. MRI lumbar spine: Normal. Echocardiogram demonstrated an ejection fraction of 55% with mitral va
CDC 'Split Type':

Write-up:Developed difficulty walking 10/23/06. Admitted on 10/25/06 to ICU with rash, inability to lift legs off bed, bilateral arm weakness, headache, shortness of breath, neck weakness, voice affected, BP increase, tachycardic, Possible pulmonary emboli, getting 7 days of IVIG. 11/8/06-neurology consultation of 10/25/06: DX severe GBS with rapid ascending weakness of all four limbs and currently he has moderate cervical neck weakness and mild shortness of breath. 12/27/06-DC Summary received and reviewed for DOS 10/25-11/09/06 DC DX: Guillain Barre Syndrome Dysphagia, improving Possible depression possible heparin induced thrombocytopenia Sinus tachycardia history sinus pause on 10/28/06. RX with 5 day course IVIG with no improvement then RX with additional 2 days for total of 7 days.DC transferred to rehab facility.


Changed on 9/14/2017

VAERS ID: 265766 Before After
VAERS Form:(blank) 1
Age:18.0
Gender:Male
Location:California
Vaccinated:2006-08-04
Onset:2006-10-23
Submitted:2006-11-01
Entered:2006-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR UE935AA / 0 1 UN / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Blood pressure increased, Cardiomyopathy, Depression, Difficulty in walking, Dysphagia, Dysphonia, Dyspnoea, Guillain-Barre syndrome, Headache, Hypokinesia, Laboratory test abnormal, Pulmonary embolism, Rash, Tachycardia, Thrombocytopenia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? Yes, days: 14     Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: Tetracycline
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Epstein Barr virus Antibodies all neg, CMV antibodies neg, Lyme disease antibody neg, D Dimer increase 3.68. Labs: chem 11/2/06 protein 8.4, albumin 5.2, calcium 10.6, alk phos 130, CBC 11/2/06-auto lymph 18.4, auto mono 11.6, auto granulocyte 82.8, EBV WNL, Cytomegalovirus AB 0.40, parathyroid hormone 41, lyme disease antibody 0.70, lead 1.8, CPI isoenzyme 56, D-Dimer 3.68, EKG: left atrial abnormality, early repolarization, MRI thoracic spine: multilevel degenerative disease MRI brain: no evidence for intracerebral mass, shift or bleed. Small fluid collection within right petrous apex which probably represents a small petrus apes effusion. MRI lumbar spine: Normal. Echocardiogram demonstrated an ejection fraction of 55% with mitral va valve prolapse. Doppler US of bilateral lower extremities negative for DVT. Outpatient MRI of brain, thoracic and lumbar spine negative. CXR: acute cardiopulmonary disease.
CDC 'Split Type':

Write-up:Developed difficulty walking 10/23/06. Admitted on 10/25/06 to ICU with rash, inability to lift legs off bed, bilateral arm weakness, headache, shortness of breath, neck weakness, voice affected, BP increase, tachycardic, Possible pulmonary emboli, getting 7 days of IVIG. 11/8/06-neurology consultation of 10/25/06: DX severe GBS with rapid ascending weakness of all four limbs and currently he has moderate cervical neck weakness and mild shortness of breath. 12/27/06-DC Summary received and reviewed for DOS 10/25-11/09/06 DC DX: Guillain Barre Syndrome Dysphagia, improving Possible depression possible heparin induced thrombocytopenia Sinus tachycardia history sinus pause on 10/28/06. RX with 5 day course IVIG with no improvement then RX with additional 2 days for total of 7 days.DC transferred to rehab facility.


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