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This is VAERS ID 621153

Case Details

VAERS ID: 621153 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Female  
Location: South Carolina  
   Days after vaccination:826
Submitted: 2016-01-27
   Days after onset:470
Entered: 2016-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Private
Symptoms: Activities of daily living impaired, Allodynia, Alopecia, Antinuclear antibody negative, Anxiety, Asthma, Blood potassium decreased, Borrelia test negative, Condition aggravated, Dizziness, Dysgraphia, Dyspnoea, Electrocardiogram QT prolonged, Electromyogram abnormal, Familial periodic paralysis, Fatigue, Feeling abnormal, Hypokalaemia, Hypomagnesaemia, Migraine, Monoplegia, Muscular weakness, Nausea, Neuropathy peripheral, Nystagmus, Pain in extremity, Paraesthesia, Pruritus, Psychiatric evaluation normal, Seizure like phenomena, Tachycardia, Thyroid function test normal, Vomiting, Walking aid user, Wheelchair user
SMQs:, Torsade de pointes/QT prolongation (narrow), Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Asthma/bronchospasm (narrow), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Torsade de pointes, shock-associated conditions (narrow), Dementia (broad), Congenital, familial and genetic disorders (narrow), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Montelukast for asthma; PRN albuterol inhaler (not taken recently prior to vaccine).
Current Illness: No active illness.
Preexisting Conditions: Asthma, hemiplegic migraine (well-controlled)
Diagnostic Lab Data: Lupus ANA negative; Lyme negative; Thyroid- WNL; Hypokalemia in 12/2014; EMG shows "Irregularities" in neurological portion. No irregularities in muscular testing. Psych eval normal. No Axis 1 or 2 dx.
CDC Split Type:

Write-up: Pt has a hx of: Bullseye Rash as a child; Mononucleosis at age 5; hemiplegic migraine at age 8, well controlled, medicated ages 8-11. No sx after mediation d/c''d. At age 12, had 3 does of HPV-4 Gardasil (11/2012, 2/2013, 7/2013). Began having increased asthma attacks, dizziness and anxiety in October, 2013. October, 2014 developed weakness of left arm, left leg. Tingling in face. December 2014- ER admission for severe hypokalemia, hypomagnesemia, tachycardia, prolonged QT interval. Sx include: Muscle weakness, Migraines, Seizure-like activity, Hypokalemia, Fatigue, Pruritis, Shortness of breath with simple activity, Alopecia, Neuropathy, Allodynia, Nystagmus, Nausea/vomiting, Periodic Paralysis, Left arm severe pain with episodes of paralysis, Brain fog, Inability to write or perform ADLs, Needed walker or wheelchair for mobility, Difficulty breathing during attacks, On home-bound schooling. Diagnosed with Hypokalemic Periodic Paralysis in 11/2015.

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