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This is VAERS ID 326520

Case Details

VAERS ID: 326520 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Alabama  
Vaccinated:2008-06-27
Onset:2008-07-07
   Days after vaccination:10
Submitted: 2008-09-29
   Days after onset:84
Entered: 2008-09-30
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1758U / 1 LA / -
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2566AA / 1 LA / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2862AA / 1 RA / UN

Administered by: Other       Purchased by: Other
Symptoms: Activities of daily living impaired, Blood test, Headache, Hypoaesthesia, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Dementia (broad), Guillain-Barre 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: ELAVIL; NEXIUM; NEURONTIN; CLARITIN
Current Illness:
Preexisting Conditions: Infectious mononucleosis. PMH: none. Allergy to sulfa.
Allergies:
Diagnostic Lab Data: Laboratory test, blood work. Labs and Diagnostics: AST 45. ALT 86. monospot (-). ESR 27, 51. ANA (-). RF (-). Lyme (-). EBV c/w acute infection. Abd US WNL. CPK 53. EBV (-). MRI brain and C-spine WNL.
CDC Split Type: WAES0809USA04230

Write-up: Information has been received from a physician concerning a 12 year old female with a history of infectious mononucleosis, who "about two months ago" (approximately in July 2008) was vaccinated with the first dose of GARDASIL, a dose of MENACTRA and another unspecified vaccine. Concomitant therapy included NEURONTIN, ELAVIL, NEXIUM and CLARITIN. The physician stated that "about one week" after receiving vaccination, the patient developed headache, numbness, extremity tingling and pain on the left side of the body. The patient had been unable to attend school for two months because of the adverse symptoms. The patient sought medical attention with an office visit. At time of reporting, the patient had not recovered. Lab tests included a blood work with unknown results. The physician considered the adverse events to be disabling. Additional information has been requested. 12/08/2008 MR received from PCP. Seen 7/14/08 with c/o sore throat, H/A, congestion x 1 week. DX: Sinusitis-tx abx. Seen in ER 7/15/08 with same sx in addition to joint aches. Thought to be viral etiology. Seen 7/16/08 with additional stomach cramping, body aches, and red bumps on back. Worsening H/A. Worsening pain upper L side. Feels like throat is swelling up, migratory joint pain. Tx-Tylenol #3. Still c/o joint pain and difficulty sleeping. Assessment: Joint Pain/Fatigue. ? Viral Syndrome. By 8/26/08 pt worsening sx-H/A and sensory issues on the L side. Been out of school for long time. Referred to Rheumatology and Neurology. 1/5/09 MR received from Immunology and Neurology consults. 8/19/2008 and 8/26/08. Seen for c/o fatigue, H/A, back pain and joint pain. Also with c/o numbness of jaw and extremities, episodes of joint swelling, SOB, muscle tightness and nausea which began several days after receiving Gardasil vax. Now in home school due to intensity of sx. PE (+) for 8/10 H/a, mild (+) Romberg, point tenderness. Returned 9/16/08 for c/o disturbances of skin sensation. DX: Reflex Symphathetic Dystrophy, GER. Episode 9/18/08 of severe H/A , bilateral arm and leg pain, fever, shaking and vomiting resulting in ER visit. Assessment: Acute viral illness exacerbating chronic pain d/o.


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