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This is VAERS ID 291301

Case Details

VAERS ID: 291301 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: Massachusetts  
   Days after vaccination:0
Submitted: 2007-09-13
   Days after onset:2
Entered: 2007-09-25
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Public
Symptoms: Abdominal pain, Chest X-ray, Chest X-ray normal, Computerised tomogram abnormal, Dehydration, Dizziness, Full blood count, Urinary system X-ray, Vomiting, White blood cell count increased
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Rx prescribed by pts. GYN to moderate periods.
Current Illness: None
Preexisting Conditions: Idiopathic lower extremity edema
Diagnostic Lab Data: Abd/pelvic CT - small amt fluid in cul-de-sac - o/w negative; - KUB; - CXR; CBC; WBC 21,600 with 87 polys/4 bands 10/4/07-diagnostic reports received for DOS 9/11-9/12/07-WBC 21.6, Poly 87, Glucose 170, Bilirubin total 1.45, urine ketones 40, mono positive, Blood culture no growth. EBV CAPSID IgM positive.CT abdomen and pelvis trace amount fluid in cul-de-sac, left ovary slightly larger than right. Consistent with mittelschmerz. Leukocytosis 21,600. Amylase 50 and lipase 15. Mono test positive.
CDC Split Type:

Write-up: Pt developed abd. pain, vomiting within 1 hr of vaccine administration. Also was lightheaded (dizzy) - evaluated in ER and admitted for IV hydration (dehydrated) 11/6/07-records received for DOS 9/11-9/12/07-DC DX: Vomiting resolved. Dehydration resolved. Admitted with complaint of vomiting and abdominal pain which began yesterday suddenly.

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