| VAERS ID: |
336473 (history) |
| Form: |
Version 1.0 |
| Age: |
18.0 |
| Sex: |
Female |
| Location: |
Tennessee |
| Vaccinated: | 2007-08-07 |
| Onset: | 2007-09-01 |
| Days after vaccination: | 25 |
| Submitted: |
2008-12-23 |
| Days after onset: | 479 |
| Entered: |
2009-01-05 |
| Days after submission: | 13 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HEPA: HEP A (VAQTA) / MERCK & CO. INC. |
0804F / 1 |
LA / IM |
| HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
0171U / 1 |
LA / IM |
| MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR |
U2207AA / 1 |
RA / IM |
| TDAP: TDAP (ADACEL) / SANOFI PASTEUR |
C2457AA / 1 |
LA / IM |
Administered by: Private Purchased by: Private
Symptoms: Asthenia,
Biopsy muscle,
Death,
Dysphagia,
Fatigue,
Headache,
Immunoglobulin therapy,
Muscle atrophy,
Myalgia,
Nuclear magnetic resonance imaging,
Pain in extremity,
Weight decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died: 2009-03-23
Days after onset: 569
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Iron-deficiency anemia
Allergies:
Diagnostic Lab Data: muscle biopsy; MRI separate. Dx clinical myositis
CDC Split Type:
Write-up: Onset increased muscle pain, fatigue, weakness, dysphagia, weight loss. Pt requiring Prednisone IVIG every q monthly. Methotrexate headache, muscle atrophy. 2/6/09 Received PCP medical records of 11/11/08-1/20/09. FINAL DX: polymyositis, likely MCV4 vaccine related; osteomalacia; neuropathy; pernicious anemia; tachycardia; ataxia; Budd-Chiari syndrome; dermatomyositis. Records reveal patient experienced muscle weakness, paresthesias, leg pain. Referred to Neuro & Rheum. Tx w/PT & meds including methotrexate, imuran, steroids, enbrel, bicillin, IVGG. Had to drop out of college due to illness. 04/6/2010 Patient''s condition never improved and she died on 3/23/2009. |
