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This is VAERS ID 341635

Event Details Report
VAERS ID:341635  Vaccinated:2009-03-11
Age:11.0  Onset:2009-03-11, Days after vaccination: 0
Gender:Female  Submitted:2009-03-12, Days after onset: 1
Location:Texas  Entered:2009-03-12, Days after submission: 0
Life Threatening Illness? No
Died? No
Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Current Illness: COUGH 3/18/09-records received-Mild upper respiratory symptoms and cough for 3 days prior.
Diagnostic Lab Data: 3/18/09-records received- BUN/creat ratio increased 28.0.
Previous Vaccinations:
Other Medications:
Preexisting Conditions: 3/18/09-records received-PMH:abdominal pain, H. pylori, lactose intolerance. Allergic rhinitis.
CDC 'Split Type':
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPUNKNOWN MANUFACTURER  IMUN
HPVUNKNOWN MANUFACTURER  IMUN
MENUNKNOWN MANUFACTURER  IMUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abasia, Arthralgia, Back pain, Pain in extremity
Write-up: MOM STATE FEW MINUTES AFTER VACCINE PT COMPLAIN OF PAIN LOWER BACK RADIATING TO BOTH HIP AND LEGS THEN GOT WORST UNABLE TO WALK AND ADMITTED FOR EVALUATION 3/18/09-records received for DOS 3/12-3/13/09-DC DX Acute myalgia post vaccination. Bronchitis. Presented with bilateral hip pain and upper legs and associated heaviness feeling and weakness of legs. Symptoms began 30 minutes after vaccinations. Unable to walk due to pain in legs.

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