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This is VAERS ID 275622

Case Details

VAERS ID: 275622 (history)  
Form: Version 1.0  
Age: 17.0  
Gender: Female  
Location: Arizona  
Vaccinated:2007-02-21
Onset:2007-02-22
   Days after vaccination:1
Submitted: 2007-04-04
   Days after onset:40
Entered: 2007-04-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1209F / 2 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0263U / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2209AA / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Asthenia, Hypotonia, Muscular weakness, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Minocycline, Dafferin gel
Current Illness: U.T.I.
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Dr examined referred to PT and neurology consult.
CDC Split Type:

Write-up: Pt c/o pain and weakness in Lt arm persistent since admin. of vaccine in Lt arm. Dr notes pt has decrease muscle strength in Lt arm unable to make a fist and decrease tone in Lt arm. 4/10/07 Received medical records from PCP which include vax records & reveal that on day of vax patient experienced UTI s/s, UA was done & patient started on antibiotics. Returned to PCP on 4/4/07 w/complaints of left arm weakness since vax. Exam revealed decreased left arm muscle strength. Patient was unable to make a fist w/left hand & had decreased muscle tone in left arm. Received neuro & PT referrals.


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