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This is VAERS ID 350543

Case Details

VAERS ID: 350543 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: California  
   Days after vaccination:10
Submitted: 2009-06-28
   Days after onset:605
Entered: 2009-06-30
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Unknown
Symptoms: Arthralgia, Bedridden, Constipation, Disturbance in attention, Dyskinesia, Fatigue, Feeling abnormal, Headache, Hypotension, Loss of consciousness, Nausea, Pain in extremity, Rash, Syncope, Weight decreased
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dyskinesia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (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? Yes, 7 days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: None. Birth control pills.
Current Illness: None
Preexisting Conditions: None. 7/20/09 Hospital records received DOS 7/18/08 to 7/13/09. Fibromyalgia/chronic pain, platelet dysfunction, Lyme disease, orthostatic hypotension. Allergy to Stimate. Head trauma. Leg injury. Irregular menses. 7/1/09 Received medical records w/PMH: Excercise-induced asthma.
Diagnostic Lab Data: 7/20/09 Hospital records received DOS 7/18/08 to 7/13/09. LABS and DIAGNOSTICS. Upper GI Series Normal. Abdominal Ultrasound Normal. CBC Normal. Metabolic Panel Normal. MRI/MRA Normal. Cortisol Stimulation Test WNL. Lyme titer - Borderline positive. Additional multiple labs and imaging studies WNL - refer to patient records. 7/1/09 Received medical records w/LABS and DIAGNOSTICS: T-4 0.8 ng/dL (L). Numerous immunological tests unremarkable.
CDC Split Type:

Write-up: Faints - blacks out - low blood pressure. Extreme pain in legs and body. Body jerks no concentration brain fog. Rashes, joint pain Fatigue, constipation weight loss - nausea. Headaches bedridden long periods. 7/20/09 Hospital records received DOS 7/18/08 to 7/13/09. Assessment: Orthostatic hypotension and Fibromyalgia. Syncope and Collapse. Migraine. Aversion to eating. Chronic pain syndrome. Multiple ER visits and hospitalizations. Chronic diarrhea and dizzy spells. Decreased PO intake. Weight loss. Headache, blurry vision. Mental status change. Confusion, inability to eat. Uncontrolled pain. Loss of consciousness. On birth control pills. Constipation. 9/4/09 Received ICD9 codes: 4516; 43239; 4580; 7291; 27651; 78701; 78321; 78052; 3384; 56400; 2871. 7/1/09 Medical records received DOS 6/20/07 to 12/24/07 Assessment: Fatigue, arthralgia, myalgia, easy bruising, lack of concentration. Patient presnts with lower leg pain, aching, sore arms, ankle bruising. Heavy menstrual period. Lack of concentration. Allergies. Painful skin with light touch. Constipation, SOB with excercise. Illness at time of immunization: Tired, not sleeping well. Body aches. Stress at school. Sore throat, Amox.

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