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This is VAERS ID 406578

Case Details

VAERS ID: 406578 (history)  
Age: 12.0  
Gender: Female  
Location: Michigan  
Vaccinated:2010-05-12
Onset:2010-05-17
   Days after vaccination:5
Submitted: 2010-11-01
   Days after onset:168
Entered: 2010-11-02
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB365CA / 0 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0969Y / 0 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U3068AA / 0 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U3052AA / 5 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1048S / 1 LA / SC

Administered by: Public       Purchased by: Private
Symptoms: Alopecia, Antinuclear antibody positive, Antiphospholipid antibodies positive, Arthritis, Autoimmune disorder, Cognitive disorder, Dry eye, Epistaxis, Fatigue, Lethargy, Memory impairment, Multiple sclerosis, Sjogren's syndrome, Systemic lupus erythematosus
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (narrow), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Optic nerve disorders (broad), Demyelination (narrow), Corneal disorders (broad), Depression (excl suicide and self injury) (broad), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Arthritis (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Autoimmune.~Varicella (no brand name)~UN~12.00~Patient|Autoimmune~HPV (Gardasil)~1~12.00~Patient
Other Medications: not at this time
Current Illness: none
Preexisting Conditions: eczema born - colic 3 wks old to 8 mos old
Diagnostic Lab Data: 10/18/2010 more lupus 1:320 positive ANA testing TBD 11/10/10
CDC Split Type:

Write-up: Memory and cognitive deficit May to present - Hair loss, nose bleeds, fatigue, lethargy, dry eyes, positive ANA test for an autoimmune Dx for either lupus, MS, arthritis and Sjorgrens Dr - neuro hospital. Continues treatment.


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