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This is VAERS ID 622700

Case Details

VAERS ID: 622700 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Foreign  
   Days after vaccination:30
Submitted: 2016-02-12
   Days after onset:1075
Entered: 2016-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Military       Purchased by: Public
Symptoms: Allodynia, Alopecia, Arthralgia, Asthenia, Autonomic nervous system imbalance, Chills, Complex regional pain syndrome, Costochondritis, Disability, Dizziness, Facial paresis, Fatigue, Fibromyalgia, Gastrointestinal disorder, Gastrooesophageal reflux disease, Headache, Hypotension, Hypothermia, Injection site oedema, Injection site pain, Insomnia, Myalgia, Nausea, Pain, Pain in extremity, Paraesthesia, Paresis, Polyneuropathy, Presyncope, Raynaud's phenomenon, Spinal pain, Swelling, Tachycardia, Tonic clonic movements, Tremor, Underweight
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Dehydration (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: None
Current Illness: None
Preexisting Conditions: Asthma and allergies.
Diagnostic Lab Data: Complex regional pain syndrome, dysautonomia, polyneuropathy, fibromyalgia
CDC Split Type:

Write-up: Pain, Edema, Right arm (immunization site) strength loss, Reynaud Phenomenon, Joint pain. 15 days later pain on the left side arm, one month after presented pain in the low body section. Generalized strength loss, Disability, Fibromyalgia, paresthesia, paresis, chronic pain, chronic fatigue, arthralgia, myalgia, allodynia, costochondritis, headaches, insomnia, spinal pain, dizziness, nausea, hypotension, gastroesophageal reflux, gastrointestinal disorder, dysautonomia, tachycardia, distal hypothermia, swelling, hair loss, tremors, facial paresis, Tonic-clonic movements, presyncope, Shaking chills, low weight. Current treated with painkillers, anti-convulsives and steroids.

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