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This is VAERS ID 341419

Case Details

VAERS ID: 341419 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: New Hampshire  
Submitted: 2009-02-12
Entered: 2009-03-10
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Public
Symptoms: Abasia, Blood test, Cardiac monitoring, Disturbance in attention, Headache, Insomnia, Nuclear magnetic resonance imaging, Syncope, Vaccine positive rechallenge, Visual acuity reduced
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None 5/18/09 medical records received DOS 12/1/08 to 4/8/09. benzaclin, albuterol, Pediazole
Current Illness: None
Preexisting Conditions: Asthma
Diagnostic Lab Data: MRI; EEG; Heart monitor; Blood work. 5/18/09 hospital records received DOS 3/5/09 to 3/6/09. LABS and DIAGNOSTICS: Urinalysis - hazy, protein trace, leukocyte esterase, WBC 2, RBC 1, bacteria moderate, squamous epithelial cells 5, transitional epithelial cells <1. EEG normal. EKG NSR. MRI brain normal. 5/18/09 medical records received - includes neuro consult - DOS 12/1/08 to 4/8/09. LABS and DIAGNOSTICS: EEG - generalized spike and slow wave activity. EKG WNL. Holter Monitor WNL. MRI WNL. CBC WNL. Metabolic profile WNL. TSH WNL.
CDC Split Type:

Write-up: 8/1/08- 1st shot- fainting began, headaches. 10/2/08-2nd shot- fainting + headaches continue inability to sleep or concentrate, inability to see or have use of her legs during fainting, sensitive nerves. 5/18/09 hospital records received DOS 3/5/09 to 3/6/09. FINAL DIAGNOSIS: Migraine - non-classic type, urinary tract infection Post vaccination: light headedness, feels that she will fall over, floating in lower extremities, and tunnel vision. Later insomnia, syncope on standing, fell backwards with stiffening in legs. 4/5 strenght L upper extremity. Urinary tract infection. 5/18/09 medical records received - includes neuro consult - DOS 12/1/08 to 4/8/09. FINAL DIAGNOSIS: Seizures presented as syncope Post vaccination: with change of position sees dark spots. Fell backwards with episode of rigidity. Weight loss, lower abdominal pain. Acne forehead, cheeks, chin, chest. URI with cough, congestion, rhinorrhea, hoarse, sore throat, chest heavy, difficulty taking deep breaths. Neurology consult - headaches, stress, people picking on me,

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