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This is VAERS ID 361111

Case Details

VAERS ID: 361111 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: California  
   Days after vaccination:25
Submitted: 2009-10-15
   Days after onset:23
Entered: 2009-10-16
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: Other
Symptoms: Abasia, Abdominal pain, Asthenia, Computerised tomogram, Headache, Laboratory test normal
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Mental disorder
Preexisting Conditions: PMH: Obesity. DM (well controlled on PO meds). Family h/o asthma , DM and hypertension. ALlergies: NKDA
Diagnostic Lab Data: diagnostic laboratory, negative for GUILLAIN-BARRE Syndrome LABS & DIAGS: Glucose 114, CRP 2.6 (H), acetylcholine binding neg. CSF cx w/gram stain no growth. ABD U/S liver diffuse fatty infiltration mild hydronephrosis R side. EGD- mild gastritis. CT brainb neg. CT spine cervical lordosis. CXR neg. XT lumbar spin- constipation
CDC Split Type: WAES0910USA01162

Write-up: Initial and follow-up information has been received from a physician concerning a 14 year old female with unspecified mental health issues who on 28-AUG-2009 was vaccinated with a dose of GARDASIL (dose, route and LOT# not reported). On 22-SEP-2009 the patient started complaining of abdominal pain and weakness. The patient was admitted to hospital and felt fine when she discharged on 25-SEP-2009. On 27-SEP-2009 the patient went to emergency room and was admitted again for headache, weakness and being unable to walk. The labs CT of head and CT of spine were performed and no outcome provided, the GUILLAIN-BARRE Syndrome test was negative. The patient had been discharged on an unspecified date but she was still unable to walk and had weakness. No further information was available at this time of the report. The patient was hospitalized. The reporter considered the abdominal pain, weakness, headache and being unable to walk to be an incapacity or significant disability. Additional information has been requested. 11/9/09 medical records and discharge summary received for DOS 9/22-9/25 and subsequent admission 9/27/09-10/02/09. Final DX: 9/22 admission- Hiatal hernia. FInak DX 9/27 admission -Migraine Headaches, Somataform Disorder, Diabetes, Obesity Patient initially admitted for stabbing epigastric/abd pain and pain in shuoulders and back, tingling in back. CT abd and pelvis neg. diagnosed w/small hiatal hernia by endoscopy. D/C to home. Returned to ED with c/o LE weakness and back pain. Also c/o severe HA. Unable to bear weight and walks with walker. DTRs 1/4. Normal sensation. Strength 5/5. All diags neg. Somataform disorder. Refer to psych and possible rehab/PT. Homehealth. D/C using walker. HA resolving.

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