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This is VAERS ID 336473

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 336473
VAERS Form:
Age:18.0
Sex:Female
Location:Tennessee
Vaccinated:2007-08-07
Onset:2007-09-01
Submitted:2008-12-23
Entered:2009-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0804F / 0 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0171U / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) / SANOFI PASTEUR U2207AA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2457AA / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Ataxia, Biopsy muscle, Blood product transfusion, Budd-Chiari syndrome, Dermatomyositis, Dysphagia, Fatigue, Headache, Muscle atrophy, Muscular weakness, Myalgia, Neuropathy peripheral, Nuclear magnetic resonance imaging, Osteomalacia, Paraesthesia, Pernicious anaemia, Polymyositis, Tachycardia, Vaccination complication, Weight decreased, Activities of daily living impaired

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 4/7/2010

VAERS ID: 336473 Before After
VAERS Form:
Age:18.0
Sex:Female
Location:Tennessee
Vaccinated:2007-08-07
Onset:2007-09-01
Submitted:2008-12-23
Entered:2009-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0804F / 0 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0171U / 0 LA / IM
MNQ: MENINGOCOCCAL (MENACTRA) MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2207AA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2457AA / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Ataxia, Biopsy muscle, Blood product transfusion, Budd-Chiari syndrome, Dermatomyositis, Dysphagia, Fatigue, Headache, Muscle atrophy, Muscular weakness, Myalgia, Neuropathy peripheral, Nuclear magnetic resonance imaging, Osteomalacia, Paraesthesia, Pernicious anaemia, Polymyositis, Tachycardia, Vaccination complication, Weight decreased, Activities of daily living impaired

Life Threatening? Yes
Birth Defect? No
Died? No Yes
   Date died:0000-00-00 2009-03-23
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 7/31/2010

VAERS ID: 336473 Before After
VAERS Form:
Age:18.0
Sex:Female
Location:Tennessee
Vaccinated:2007-08-07
Onset:2007-09-01
Submitted:2008-12-23
Entered:2009-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0804F / 0 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0171U / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2207AA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2457AA / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Biopsy muscle, Death, Dysphagia, Fatigue, Headache, Muscle atrophy, Myalgia, Nuclear magnetic resonance imaging, Pain in extremity, Weight decreased, Immunoglobulin therapy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-03-23
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 8/31/2010

VAERS ID: 336473 Before After
VAERS Form:
Age:18.0
Sex:Female
Location:Tennessee
Vaccinated:2007-08-07
Onset:2007-09-01
Submitted:2008-12-23
Entered:2009-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0804F / 0 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0171U / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2207AA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2457AA / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Biopsy muscle, Death, Dysphagia, Fatigue, Headache, Muscle atrophy, Myalgia, Nuclear magnetic resonance imaging, Pain in extremity, Weight decreased, Red blood cell sedimentation rate, Immunoglobulin therapy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-03-23
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 1/4/2011

VAERS ID: 336473 Before After
VAERS Form:
Age:18.0
Sex:Female
Location:Tennessee
Vaccinated:2007-08-07
Onset:2007-09-01
Submitted:2008-12-23
Entered:2009-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0804F / 0 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0171U / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2207AA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2457AA / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Biopsy muscle, Death, Dysphagia, Fatigue, Headache, Muscle atrophy, Myalgia, Nuclear magnetic resonance imaging, Pain in extremity, Weight decreased, Red blood cell sedimentation rate, Immunoglobulin therapy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-03-23
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 4/13/2011

VAERS ID: 336473 Before After
VAERS Form:
Age:18.0
Sex:Female
Location:Tennessee
Vaccinated:2007-08-07
Onset:2007-09-01
Submitted:2008-12-23
Entered:2009-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0804F / 0 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0171U / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2207AA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2457AA / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Ataxia, Biopsy muscle, Budd-Chiari syndrome, Death, Dermatomyositis, Dysphagia, Fatigue, Headache, Muscle atrophy, Muscular weakness, Myalgia, Neuropathy peripheral, Nuclear magnetic resonance imaging, Osteomalacia, Pain in extremity, Paraesthesia, Pernicious anaemia, Polymyositis, Tachycardia, Weight decreased, Activities of daily living impaired, Immunoglobulin therapy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-03-23
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 5/13/2011

VAERS ID: 336473 Before After
VAERS Form:
Age:18.0
Sex:Female
Location:Tennessee
Vaccinated:2007-08-07
Onset:2007-09-01
Submitted:2008-12-23
Entered:2009-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0804F / 0 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0171U / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2207AA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2457AA / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Ataxia, Biopsy muscle, Budd-Chiari syndrome, Death, Dermatomyositis, Dysphagia, Fatigue, Headache, Muscle atrophy, Muscular weakness, Myalgia, Neuropathy peripheral, Nuclear magnetic resonance imaging, Osteomalacia, Pain in extremity, Paraesthesia, Pernicious anaemia, Polymyositis, Tachycardia, Weight decreased, Activities of daily living impaired, Immunoglobulin therapy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-03-23
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 6/11/2011

VAERS ID: 336473 Before After
VAERS Form:
Age:18.0
Sex:Female
Location:Tennessee
Vaccinated:2007-08-07
Onset:2007-09-01
Submitted:2008-12-23
Entered:2009-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0804F / 0 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0171U / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2207AA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2457AA / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Ataxia, Biopsy muscle, Budd-Chiari syndrome, Death, Dermatomyositis, Dysphagia, Fatigue, Headache, Muscle atrophy, Muscular weakness, Myalgia, Neuropathy peripheral, Nuclear magnetic resonance imaging, Osteomalacia, Pain in extremity, Paraesthesia, Pernicious anaemia, Polymyositis, Tachycardia, Weight decreased, Activities of daily living impaired, Immunoglobulin therapy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-03-23
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 2/13/2012

VAERS ID: 336473 Before After
VAERS Form:
Age:18.0
Sex:Female
Location:Tennessee
Vaccinated:2007-08-07
Onset:2007-09-01
Submitted:2008-12-23
Entered:2009-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0804F / 0 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0171U / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2207AA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2457AA / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Ataxia, Biopsy muscle, Budd-Chiari syndrome, Cardio-respiratory arrest, Death, Dermatomyositis, Dysphagia, Fatigue, Headache, Muscle atrophy, Muscular weakness, Myalgia, Neuropathy peripheral, Nuclear magnetic resonance imaging, Osteomalacia, Pain in extremity, Paraesthesia, Pernicious anaemia, Polymyositis, Tachycardia, Weight decreased, Activities of daily living impaired, Immunoglobulin therapy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-03-23
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 4/14/2017

VAERS ID: 336473 Before After
VAERS Form:
Age:18.0
Sex:Female
Location:Tennessee
Vaccinated:2007-08-07
Onset:2007-09-01
Submitted:2008-12-23
Entered:2009-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0804F / 0 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0171U / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2207AA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2457AA / 0 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Ataxia, Biopsy muscle, Budd-Chiari syndrome, Cardio-respiratory arrest, Death, Dermatomyositis, Dysphagia, Fatigue, Headache, Muscle atrophy, Muscular weakness, Myalgia, Neuropathy peripheral, Nuclear magnetic resonance imaging, Osteomalacia, Pain in extremity, Paraesthesia, Pernicious anaemia, Polymyositis, Tachycardia, Weight decreased, Activities of daily living impaired, Immunoglobulin therapy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-03-23
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 9/14/2017

VAERS ID: 336473 Before After
VAERS Form:(blank) 1
Age:18.0
Sex:Female
Location:Tennessee
Vaccinated:2007-08-07
Onset:2007-09-01
Submitted:2008-12-23
Entered:2009-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0804F / 0 1 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0171U / 0 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U2207AA / 0 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C2457AA / 0 1 LA / IM

Administered by: Private      Purchased by: Private
Symptoms: Asthenia, Biopsy muscle, Death, Dysphagia, Fatigue, Headache, Muscle atrophy, Myalgia, Nuclear magnetic resonance imaging, Pain in extremity, Weight decreased, Immunoglobulin therapy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-03-23
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 2/14/2018

VAERS ID: 336473 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:Tennessee
Vaccinated:2007-08-07
Onset:2007-09-01
Submitted:2008-12-23
Entered:2009-01-05
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, Muscle atrophy, Myalgia, Nuclear magnetic resonance imaging, Pain in extremity, Weight decreased, Immunoglobulin therapy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-03-23
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 6/14/2018

VAERS ID: 336473 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:Tennessee
Vaccinated:2007-08-07
Onset:2007-09-01
Submitted:2008-12-23
Entered:2009-01-05
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, Muscle atrophy, Myalgia, Nuclear magnetic resonance imaging, Pain in extremity, Weight decreased, Immunoglobulin therapy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-03-23
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 8/14/2018

VAERS ID: 336473 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:Tennessee
Vaccinated:2007-08-07
Onset:2007-09-01
Submitted:2008-12-23
Entered:2009-01-05
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, Muscle atrophy, Myalgia, Nuclear magnetic resonance imaging, Pain in extremity, Weight decreased, Immunoglobulin therapy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-03-23
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 9/14/2018

VAERS ID: 336473 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:Tennessee
Vaccinated:2007-08-07
Onset:2007-09-01
Submitted:2008-12-23
Entered:2009-01-05
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, Muscle atrophy, Myalgia, Nuclear magnetic resonance imaging, Pain in extremity, Weight decreased, Immunoglobulin therapy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-03-23
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 10/14/2018

VAERS ID: 336473 Before After
VAERS Form:1
Age:18.0
Sex:Female
Location:Tennessee
Vaccinated:2007-08-07
Onset:2007-09-01
Submitted:2008-12-23
Entered:2009-01-05
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, Muscle atrophy, Myalgia, Nuclear magnetic resonance imaging, Pain in extremity, Weight decreased, Immunoglobulin therapy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2009-03-23
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.

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