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This is VAERS ID 414486

Case Details

VAERS ID: 414486 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: California  
Vaccinated:2008-02-18
Onset:2008-06-28
   Days after vaccination:131
Submitted: 2011-01-11
   Days after onset:927
Entered: 2011-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0928U / 2 UN / UN
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR U2382BA / UNK UN / UN
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B019AA / UNK UN / UN

Administered by: Private       Purchased by: Public
Symptoms: Abasia, Antinuclear antibody positive, Body temperature increased, Juvenile arthritis, Pain, Rheumatoid arthritis
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (narrow), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: ANA confirming systemic Juvenile Rheumatoid Arthritis
CDC Split Type:

Write-up: Patient''s body temperature went up to 104 and she couldn''t walk. She was is a lot of pain and was admitted to the hospital.


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