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This is VAERS ID 629221

Case Details

VAERS ID: 629221 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Michigan  
   Days after vaccination:350
Submitted: 2016-03-24
   Days after onset:906
Entered: 2016-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Public       Purchased by: Other
Symptoms: Acne, Alopecia, Anxiety, Asthenia, Autonomic nervous system imbalance, Bone pain, Cognitive disorder, Decreased appetite, Depression, Fatigue, Gastrointestinal disorder, Myalgia, Quality of life decreased, Rash generalised, Weight decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (narrow), Osteonecrosis (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Ritalin, Albuterol as needed
Current Illness: None
Preexisting Conditions: Fungi, Epstein Barr Syndome
Diagnostic Lab Data: Cardiologist, Dysautonomia; GI Specialist, GI and Weight Loss issues; Family Doctor for ongoing health issues
CDC Split Type:

Write-up: Systemic Rash, Followed by a slow progression of symptoms, weight loss, fatigue, lack of appetite, bone pain, muscle pain, weakness, hair loss, acne-severe, depression, anxiety, comprehension and cognitive difficulty, dysautonomia, GI issues, diminished quality of life.

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