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This is VAERS ID 350543

History of Changes from the VAERS Wayback Machine

First Appeared on 12/8/2009

VAERS ID: 350543
Age:14.0
Gender:Female
Location:California
Vaccinated:2007-10-22
Onset:2007-11-01
Submitted:2009-06-28
Entered:2009-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2486AA / - RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1063U / 0 UN / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Arthralgia, Confusional state, Constipation, Diarrhoea, Disturbance in attention, Dizziness, Dyskinesia, Dyspnoea exertional, Eating disorder, Fatigue, Feeling abnormal, Full blood count normal, Headache, Hypotension, Loss of consciousness, Menorrhagia, Migraine, Myalgia, Nausea, Nuclear magnetic resonance imaging brain normal, Oral contraception, Orthostatic hypotension, Pain, Pain in extremity, Rash, Skin discomfort, Syncope, Thyroxine decreased, Vision blurred, Weight decreased, Mental status changes, Fibromyalgia, Bedridden, Contusion, Ultrasound abdomen normal, Bacterial test positive, X-ray gastrointestinal tract normal, Angiogram normal, Metabolic function test, Hypophagia, ACTH stimulation test normal

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 7     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
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.


Changed on 7/7/2013

VAERS ID: 350543 Before After
Age:14.0
Gender:Female
Location:California
Vaccinated:2007-10-22
Onset:2007-11-01
Submitted:2009-06-28
Entered:2009-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2486AA / - RA / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2486AA / - RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1063U / 0 UN / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Arthralgia, Confusional state, Constipation, Diarrhoea, Disturbance in attention, Dizziness, Dyskinesia, Dyspnoea exertional, Eating disorder, Fatigue, Feeling abnormal, Full blood count normal, Headache, Hypotension, Loss of consciousness, Menorrhagia, Migraine, Myalgia, Nausea, Nuclear magnetic resonance imaging brain normal, Oral contraception, Orthostatic hypotension, Pain, Pain in extremity, Rash, Skin discomfort, Syncope, Thyroxine decreased, Vision blurred, Weight decreased, Mental status changes, Fibromyalgia, Bedridden, Contusion, Ultrasound abdomen normal, Bacterial test positive, X-ray gastrointestinal tract normal, Angiogram normal, Metabolic function test, Hypophagia, ACTH stimulation test normal

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 7     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
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.


Changed on 4/14/2017

VAERS ID: 350543 Before After
Age:14.0
Gender:Female
Location:California
Vaccinated:2007-10-22
Onset:2007-11-01
Submitted:2009-06-28
Entered:2009-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U2486AA / - RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1063U / 0 UN / UN

Administered by: Private      Purchased by: Unknown
Symptoms: Arthralgia, Confusional state, Constipation, Diarrhoea, Disturbance in attention, Dizziness, Dyskinesia, Dyspnoea exertional, Eating disorder, Fatigue, Feeling abnormal, Full blood count normal, Headache, Hypotension, Loss of consciousness, Menorrhagia, Migraine, Myalgia, Nausea, Nuclear magnetic resonance imaging brain normal, Oral contraception, Orthostatic hypotension, Pain, Pain in extremity, Rash, Skin discomfort, Syncope, Thyroxine decreased, Vision blurred, Weight decreased, Mental status changes, Fibromyalgia, Bedridden, Contusion, Ultrasound abdomen normal, Bacterial test positive, X-ray gastrointestinal tract normal, Angiogram normal, Metabolic function test, Hypophagia, ACTH stimulation test normal

Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, days: 7     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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