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This is VAERS ID 503396

Case Details

VAERS ID: 503396 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Male  
Location: California  
   Days after vaccination:5
Submitted: 2013-09-21
   Days after onset:452
Entered: 2013-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: Private
Symptoms: Cardiomyopathy, Echocardiogram abnormal, Electroencephalogram abnormal, Hemiparesis, Ischaemic stroke, Nuclear magnetic resonance imaging brain abnormal, Ventricular arrhythmia
SMQs:, Torsade de pointes/QT prolongation (broad), Ventricular tachyarrhythmias (narrow), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow)

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, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Insulin
Current Illness: No
Preexisting Conditions: Diabetes, toe walker
Diagnostic Lab Data: Echo Cardio gram showing LV noncompaction cardiomyopathy; MRI of brain showing stroke right ischemic stroke; EEG showing ventricular arrthymias; He was transferred to another hospital
CDC Split Type:

Write-up: I do not know the time of the incident. But he presented to ER with left sided weakness. He was found to have had a stroke and to have LV noncompaction cardiomyopathy.

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