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This is VAERS ID 284274

Case Details

VAERS ID: 284274 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Arizona  
   Days after vaccination:1
Submitted: 2007-07-09
   Days after onset:5
Entered: 2007-07-11
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Private
Symptoms: Dizziness, Dyspnoea, Headache, Nausea, Pain, Palpitations, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zantac, Albuterol, Pulmicort
Current Illness: None
Preexisting Conditions: None 3/20/09-records received- PMH:asthma, reflux disease, syncope, migraine headache.
Diagnostic Lab Data: 3/30/09-records received- MRI of brain right posterior cerebral artery is noted to be small. CT of head demonstrates no mases. Labs WNL.Cardiac workup normal. 4/25/08 Esophagogastroduodenoscopy with gastric biopsy negative.
CDC Split Type:

Write-up: Heart palpations, dizziness, headache, nausea, SOB - hurt to breathe, fever 3/30/09-records received-office visit 10/26/07-follow up of asthma since prior visit 1 year ago. No asthma flares has had significant exercise induced bronchospasm sysmptoms, exercise pretreatment is inconsistent. Office visit 2/12/08-C/O headche comes and goes, some blurring of vision mostly right eye, light sensitivity and sound sensitivity with nausea. Cheecks feel hot with headache. Currently menstrating. Family history of migraine. ER visit for headace pain. Now with neck pain on right side with right arm felt weak.New glasses Rx makes vision blurry and not helping her eye sight. Old rib injury in December. Assessment: headache, cervical subluxation. 4/11/08-follow-up for asthma, episode of shortness of breath. Intermittent abdominal pain into right lower quadrant especially when nauseated. Similar to reflux symptoms. 4/23/08-3 week history of abdominal pain, nausea vomiting and bloody emesis. Pain in epigastric region and right upper quadrant mid area. Assessment:epigastric pain secondary to gastritis or gastric ulcer disease. 1/10/09-evaluation for headaches, dizziness and syncopal episodes. Behavior started in 9/08 with dizziness and passing out episodes. Second episode in December with dizziness and collapsed and unresponsive and confused. C/O pain behind right eye, numbness and inability to move left leg for 30 minutes. Assessment: migraine headache. Vertigo. Functional component in patient''s behavior.1/17/09- C/O dizziness and nausea and not feeling well. 2/20/09 presented to ED with altered LOC, can not remember events of day. Diagnosis:migraine variant. Office visit 2/23/09-follow up for C/O right upper quadrant abdominal pain with multiple vague complaints. Assessment:psychological and panic attacks.

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