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This is VAERS ID 367604

Case Details

VAERS ID: 367604 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: California  
   Days after vaccination:247
Submitted: 2009-11-16
   Days after onset:269
Entered: 2009-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Private
Symptoms: Abdominal discomfort, Acne, Arthropod bite, Asthenia, Convulsion, Dizziness, Headache, Hyperhidrosis, Hypersomnia, Sleep disorder
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: felt weak,nausea,dizzy,passing out
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: seizure, headache,dizziness, weakness, stomach discomfort 12/17/09 clinic records received for DOS 07/31/07and 6/18/08 and vaccination list record received for DOS 12/09/1993 thr 06/18/2008. DX: Well Adolescent Care, Acne 07/31/07 office note docu. sports physical with unlimited participation. 06/18/08 office note notes c/o not sleeping well and insect bite X 1wk. Parent concerned about excessive sleep and sweats alot. Acne on face and upper back. Prescriptions given:clindamycin phosphate 1% TOP, benzoyl peroxide 6% TOP and differin 0.1% TOP. Vaccination rec reflect patient received HPV on 07/31/07, 10/09/07 and 06/18/08.

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