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This is VAERS ID 547879

Case Details

VAERS ID: 547879 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2013-09-25
Onset:2013-11-01
   Days after vaccination:37
Submitted: 2014-10-14
   Days after onset:347
Entered: 2014-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. J002641 / 1 AR / SYR
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS U4511AA / 1 AR / SYR
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS N4352 / 1 AR / SYR

Administered by: Private       Purchased by: Private
Symptoms: Abdominal pain, Chronic fatigue syndrome, Dizziness, Heart rate increased, Insomnia, Migraine, Mineral deficiency, Nausea, Postural orthostatic tachycardia syndrome, Serum ferritin decreased, Syncope, Tilt table test positive, Vitamin D decreased, Vitamin D deficiency
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amoxicillin
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Tilt Table Test (patient fainted on minute 13 of tilt when blood pressure was at 39/36, pulse went to a high of 152); Ferritin (blood) 8; Vitamin D (blood) 17
CDC Split Type:

Write-up: Postural Orthostatic Tachycardia Syndrome (POTS) (treated with salt tabs and Florinef), syncope, Chronic Fatigue Syndrome, migraines (treated with doxepin), ferritin deficiency (treated with iron supplement), vitamin D deficiency (treated with vitamin D supplement), insomnia, abdominal pain, nausea, dizziness.


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