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This is VAERS ID 375681

Case Details

VAERS ID: 375681 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Illinois  
   Days after vaccination:2
Submitted: 2010-01-03
   Days after onset:990
Entered: 2010-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Public       Purchased by: Other
Symptoms: Arthralgia, Chest pain, Chills, Confusional state, Convulsion, Cough, Depression, Dizziness, Dyspepsia, Dysphagia, Dysphonia, Dyspnoea, Feeling hot, Fibromyalgia, Gastrooesophageal reflux disease, Headache, Heat exhaustion, Hyperhidrosis, Hypersensitivity, Hypersomnia, Irritable bowel syndrome, Lethargy, Memory impairment, Myalgia, Night sweats, Odynophagia, Oropharyngeal pain, Palpitations, Somnolence, Tinnitus, Urticaria, Weight increased
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (narrow), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (narrow), Hearing impairment (narrow), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: Seizures~Influenza (H1N1) (H1N1 (MONOVALENT) (UNKNOWN))~~10.00~Sibling
Other Medications: Clonidine 0.1mg one in AM 1/2 in PM, Levoxyl once daily, Albuterol PRN.
Current Illness: No
Preexisting Conditions: Hypothyroid, Depression, Allergy to Adderal, Rapid Eye Blinking PMH: Depression, Bipolar, Asthma, Hypothyroidism, Hx of tics (blinking frequently) Allergies: Adderal, Lamictal
Diagnostic Lab Data: Patient has recieved treatment from multiple physicians and specialists and at several facilities (listed above). Medical records can be requested from each location. Dx studies: Ct abdomen and pelvis done 6/2009 wnl, Colonoscopy noted a spastic colon with internal hemorrhoids, EGD noted esophagitis, gastritis
CDC Split Type:

Write-up: Patient was treated at hospital on the following dates: 5/7/07, 5/9/07, 10/26/07, 12/09/07, 02/05/08, 03/12/08, 04/16/08, 04/17/08, 05/08/08, 10/19/08, 11/18/08/04/01/09, 05/18/09, 05/27/09, 05/28/09 through 5/31/09, 09/03/09 9/17/09, 09/20/09, 09/23/09, 10/19/09, 10/23/09, 10/26/09 through 10/28/09, 11/17/09, 11/23/09, 11/24/09, 12/14/09, and 12/25/09 for medical issues relating to adverse reaction to the Gardasil vaccine. She was also treated by multiple physicians on the following dates: 04/17/07, 05/16/07, 06/29/07, 10/08/08, 10/15/08, 11/13/08, 01/28/09, 02/11/09, 04/02/09, 05/12/09, 05/28/09, 06/02/09, 06/10/09, 07/02/09, 07/28/09, 08/12/09, 09/14/09, 09/21/09, 09/25/09 by two separate physicians, 10/09/09, 10/12/09, 10/19/09, 11/09/09, 11/16/09, 11/17/09, 11/23/09, 11/30/09, 12/02/09, 12/11/09, 12/14/09, and 01/01/10. Patient was seen and treated for the following ongoing medical issues: Fibromyalgia, environmental allergic reactions, hoarseness, coughing, shortness of breath, difficulty/pain when swallowing, continued throat pain, dizziness, repeated severe headaches, light headed, chills, overheated, excessive night sweating, lethargic, sleeping for entire day without waking rested, confusion/short term memory issues, seizures, sharp chest pains, racing heart, muscle/joint aches, hives on trunk/arms/shoulders, ringing in ears, severe depression, twisted/spastic colon, acid reflux, heartburn, weight gain. 1/4/2010 GI consult records for 9/14/2009, patient with chronic but progressively worse abdominal pain of ? etiology, increased fatigue, non-specific chest pain, change in bowel movements, alternating constipation and diarrhea, cold sweats and SOB with exertion, weakness with sensation of knees giving away

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